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THE 

DISEASE  OF  INEBRIETY 


FROM 


ALCOHOL,  OPIUM  AND  OTHER  NARCOTIC 

DRUGS, 


ITS    ETIOLOGY,   PATHOLOGY,  TREATMENT 

AND 

MEDICO-LEGAL   RELATIONS. 


ARRANGED    AND    COMPILED   BY    THE  AMERICAN 

ASSOCIATION  FOR    THE    STUDY   AND 

CURE   OF  INEBRIETY. 


NEW  YORK: 

E.  B.  TREAT  &  COMPANY, 

241-24^  WEST  23D  STREET. 
1899. 

$2.00,  n«t. 


CC)PYR]GHT,   1893, 


By  the  American  Association 

FOR  THE 

Study   and    Cure  of   Inebriety- 


o 


Cir: 


DEDICATED 

TO    THE   MEMORY   OF 

DR.  J.  EDWARD  TURNER, 

THE    PROJECTOR    AND     FOUNDER    OF     THE     FIRST 

INEBRIATE      ASYLUM      IN       THE      WORLD,      AT 

BINGHAMPTON,    NEW    YORK. 

ALSO    TO    THE    MEMORY 
OF  THOSE  PIONEERS,  NOW  PASSED  AWAY,  WHO 
FAR     IN    ADVANCE    OF    THEIR    TIMES 
ORGANIZED     THE     FIRST    SCIEN- 
TIFIC     SOCIETY     FOR     THE 
STUDY     AND   CURE    OF 
INEBRIETY  : 

DRS.    JOSEPH    PARRISH.    THEODORE    L.  MASON,  WIL- 
LARD  PARKER,  DANIEL  DODGE,  JOHN  WILLETTS, 

AND    OTHERS. 

THIS    VOLUME    IS    OFFERED     AS    A    SLIGHT    TRIBUTE 
TO    THEIR    SUPERIOR    DISCERNMENT,     AND     PRAC- 
TICAL   RECOGNITION    OF    THE  GREAT  ONCOM- 
ING    TRUTHS    OF     INEBRIETY. 


INTRODUCTION. 


In  1870  the  American  Association  for  the  Study  and  cure 
of  Inebriety  was  organized  in  New  York  City.  Its  members 
were  composed  of  physicians  connected  with  asylums  for 
Inebriates  and  others  interested  in  the  scientific  study  of  the 
drink  problem. 

The  following  statements  were  adopted  as  representing 
the  principles  and  purposes  of  the  Association  : 

1.  Inebriety  is  a  disease. 

2.  It  is  curable  as  other  diseases  are. 

3.  The  constitutional  tendency  to  this  disease  may  be 
either  inherited  or  acquired  ;  but  the  disease  is  often  in- 
duced by  the  habitual  use  of  alcohol  or  other  narcotic  sub- 
stances. 

4.  Alcohol  has  its  place  in  the  arts  and  sciences,  but  as  a 
medicine  it  is  classed  among  the  poisons,  and  its  internal 
use  is  always  more  or  less  dangerous,  and  should  be  pre- 
scribed with  great  caution. 

5.  All  methods  hitherto  employed  for  the  treatment  of 
inebriety  that  have  not  recognized  the  disordered  physical 
condition  caused  by  alcohol,  opium,  or  other  narcotics,  have 
proved  inadequate  in  its  cure  ;  hence  the  establishment  of 
Hospitals  for  the  special  treatment  of  inebriety,  in  wliicli 
such  conditions  are  recognized,  becomes  a  positive  need  of 
the  age. 

6.  In  view  of  these  facts,  and  the  increased  success  of  the 


VI  INTRODUCTION. 

treatment  in  inebriate  asylums,  this  Association  urges  that 
every  large  city  should  have  its  local  and  temporary  hospital 
for  both  the  reception  and  care  of  inebriates  ;  and  that 
every  State  should  have  hospitals  for  their  more  permanent 
detention  and  treatment. 

7.  Facts  and  experience  indicate  clearly  that  it  is  the 
duty  of  the  civil  authorities  to  recognize  inebriety  as  a  dis- 
ease, and  to  provide  means  in  hospitals  and  asylums  for  its 
scientific  treatment,  in  place  of  the  penal  methods  by  fines 
and  imprisonment  hitherto  in  use,  with  all  its  attendant  evils. 

8.  Finally,  the  officers  of  such  hospitals  and  asylums 
should  have  ample  legal  power  of  control  over  their  patients, 
and  authority  to  retain  them  a  sufficient  length  of  time  for 
their  permanent  cure. 

For  twenty-two  years  this  association  has  held  annual 
and  semi-annual  meetings  in  which  a  large  number  of 
papers  have  been  presented,  read  and  discussed. 

In  the  first  seven  years,  six  volumes  of  transactions 
were  issued,  then  a  society  journal  was  established  as  the 
official  organ  of  the  association.  This  was  called  the 
Quarterly  Journal  of  Inebriety,  which  has  been  published 
since  1877;  the  special  work  of  this  journal  has  been  to 
gather  and  group  the  scientific  literature  of  this  subject 
and  make  it  available  for  future  study. 

In  addition  to  this  literature,  many  members  of  this 
association  have  published  volumes  on  this  subject.  Of 
these  may  be  mentioned  :  "  Alcoholic  Inebriety"  by  the  late 
Dr.  Joseph  Parrish,  President  of  the  Association  ;  ** Metho- 
mania"  by  Dr.  Albert  Day,  the  present  President  ;  ^^  Inebri- 
is>n,*'  by  Dr.  T.  L.  Wright,  a  member  of  the  Association  ; 
"Inebriety,"  by  Dr.  Norman  Kerr,  of  London,  an  honorary 
member  ;  "  Alcoholism,"  by  M.  Magnan,  an  honorary  member, 
of  France  ;  "  The  Manifestations  of  Alcoholism,"  by  Dr.  Lentz, 
of  Brussels,  an  honorary  member  ;  "  Alcoholism  as  a  Malady^* 
by  Dr.  A.  Baer,  of  Berlin,  also  an  honorary  member. 


INTEODUCTION.  Vll 

III  both  this  country  and  Europe,  a  large  number  of 
valuable  papers  and  monographs  on  this  topic,  have 
appeared. 

Among  the  most  prominent  who  have  written  on  this 
subject  may  be  mentioned  Drs.  Mason,  Crothers,  Mattison, 
Mann,  Hughes,  Searcy,  Wright,  Davis,  Shepard,  Morris,  Day 
and  many  others.  Abroad,  Drs.  Peddie,  Kerr,  Clouston, 
Carpenter,  Ridge,  Richardson  and  many  of  the  most 
eminent  physicians  and  medical  teachers  of  Europe. 

A  large  part  of  these  writings  have  been  published  in 
\.\ic  Journal  of  Inebriety,  together  with  the  discussions  and 
criticisms  which  have  grown  out  of  them. 

This  literature  has  been  copied  into  medical  and  other 
journals  and  become  the  subject  of  lectures,  sermons  and 
works  on  temperance  ;  but  in  many  cases  the  original  ideas 
have  been  changed  and  modified  to  such  an  extent  as  to  be 
unrecognized.  As  a  result,  the  most  confusing  uncertainty 
and  conflict  of  opinion  exists  concerning  the  scientific 
study  of  inebriety  and  its  maladies. 

Recently,  this  subject  has  attracted  renewed  attention, 
growing  out  of  the  empiric  assumptions  of  specific  reme- 
dies for  its  cure.  Following  this,  an  increasing  demand  has 
appeared  for  some  authoritative  grouping  of  the  studies  of 
scientific  men  in  this  field,  and  suggested  the  value  of  a 
volume  comprising  some  of  the  best  papers  which  have 
been  published  in  the  journal. 

In  accordance  with  this,  the  following  resolution  was 
unanimously  adopted  at  the  November  meeting  of  the  Asso- 
ciation for  the  Study  and  Cure  of  Inebriety. 

"  Whereas,  In  view  of  the  fact  that  the  demand  for  copies 
of  the  Journal  of  Inebriety  containing  special  studies,  mono- 
graphs and  papers  on  distinct  phases  of  inebriety  is  steadily 
increasing,  together  with  constant  inquiry  from  physicians 
for  facts,  statistics  and  conclusions  relating  to  the  disease  of 
inebriety; 


Vlll  INTEODUCTION. 

"  Therefore^  resolved^  that  the  secretary  be  authorized 
to  prepare  a  volume,  wliich  shall  contain  the  most  reliable 
conclusions  and  studies  of  eminent  authorities  on  all  phases 
of  the  disease  of  inebriety  up  to  the  present  time  ;" 

^^ Resolved,  that  the  secretary,  with  the  publication  com- 
mittee, make  all  arrangements  for  the  printing  and  issuing 
of  said  volume  at  the  earliest  possible  moment. 

This  volume  is  in  conformity  with  this  resolution,  and 
simply  aims  to  give  the  reader  many  of  the  best  and  most 
suggestive  studies  of  this  subject  which  have  appeared. 

More  prominence  has  been  given  to  heredity,  treatment 
and  medico-legal  relations,  because  these  phases  are  dis- 
puted and  the  subject  of  confusing  controversy.  The  fact 
of  disease  in  inebriety  has  passed  beyond  question  and  is 
practically  settled,  hence  all  moral  theories  or  discussions 
are  of  little  or  no  value  from  a  scientific  point  of  view. 
These  various  studies  are  not  presented  as  exhaustive,  but 
rather  as  outlines  suggesting  wide  stretches  of  the  unknown, 
inviting  the  reader  to  take  up  this  subject  and  extend  its 
frontiers  far  in  advance  of  the  present. 

It  will  be  apparent  to  all  that  the  scientific  study  of  in- 
ebriety is  yet  in  its  infancy,  and  no  student  or  volume  can 
do  more  than  give  a  general  view  of  the  most  probable 
facts  which  appear  to  be  sustained  by  the  strongest  evidence 
available  up  to  this  time. 

This  volume  is  intended  to  represent  the  work  of  the 
Association  for  the  Study  and  Cure  of  Inebriety  and  the 
cliaracter  of  the  papers  and  discussions  which  have 
appeared  in  its  journal. 

For  over  a  quarter  of  a  century,  this  association  has 
studied  exclusively  the  scientific  side  oi  inebriety,  and 
although  it  has  not  attracted  much  attention  and  is  practi- 
cally unknown,  it  has  been  a  great  silent  power,  crystalliz- 
ing and  marshalling  the  many  facts  constantly  appearing 
from  a  knowledge  of  these  cases. 


INTRODUCTION.  IX 

The  drink  malady,  its  causes,  cure  and  prevention,  are 
practically  an  unoccupied  field  of  medicine,  and  this  work 
is  offered  as  a  guide  and  stimulus  to  farther  study  in  this 
direction. 

These  selections  have  been  gathered  from  over  five 
thousand  pages  of  printed  matter,  published  in  the  journal 
iiiid  transactions,  and  are  from  papers  which  have  not 
appeared  elsewhere  and  hence  will  be  new  to  most  pliysi- 
cians.  It  will  be  evident  to  tlie  reader  that  while  the  facts 
are  very  numerous  and  startling,  and  fully  sustain  the 
principles  of  the  association,  tliey  are  not  yet  sufficiently 
studied  and  generalized  to  be  accepted  as  absolute  truths. 

Tills  volume  brings  the  subject  up  to  the  frontier  lines, 
and  suggests  that  the  possibility  of  restoring  the  inebriate 
and  stamping  out  inebriety,  is  onlylimited  by  our  want  of 
knowledge  of  the  laws  and  means  to  accomplish  this  end. 
It  also  suggests  that  a  solution  of  this  great  problem  of  the 
forces  and  sources  which  develop  the  armies  of  the  inebri- 
ates or  halt  and  disband  them,  must  be  along  the  line  of 
accurately  observed  facts  and  their  meaning. 

The  purpose  of  this  work  will  be  accomplished,  if,  in  any 
way,  it  shall  help  on  this  pioneer  work. 

T.  D.  Crothers, 

Secretary. 
Hartford,  Conn. 

March,  1893. 


CONTENTS. 


CHAPTER  I. 

PAGE 

Early  history  of  the  Theory  of  Disease  in  Inebriety. — 
Opinions  and  Statements  of  authors  and  writers  in 
Europe  and  America 17 

CHAPTER  n. 
History  of  disease  theory  in  modern  times, — Dr.  Turner, 
New    York    State    Inebriate    Asylum. — American 
Association  for  the  Study  and  Cure  of  Inebriety. — 
Journal  of  Inebriety ^  etc 22 

CHAPTER  III. 
Different  forms  of  Inebriety. — Classes  of  Inebriates....     27 

CHAPTER  IV. 
Dipsomania  and  its  varieties  and  manifestations 29 

CHAPTER   V. 
Some  phases  of  the  philosophy  and  etiology  of  Inebri- 
ety.— The  higher  ranges  of  causes 39 

CHAPTER  VI. 
Inebriate  diathesis,  its  conditions  and  relations 47 

CHAPTER  VII. 
General  and  predisposing  causes  described 55 


X'l  CONTENTS. 

CHAPTER   VIII. 

PAGE 

Special  exciting  causes. — Traumatism  nnd  injury 66 

CHAPTER  IX. 
Special  causes   continued,  Adversity,  Sunstroke,  Heat, 

and  other  causes 79 

CHAPTER   X. 
Inebriety  in  America. — Some  of  its  peculiarities,  etc. ..     90 

CHAPTER  XI. 
Prevalence  and  mortality  of  Inebriety. — Fatality  in  epi- 
demics, etc 100 

CHAPTER  XII. 
Relation    between    Inebriety    and    Consumption,    etc., 

etc 103 

CHAPTER   XIII. 
Effects  of  alcohol  and  beer  on  mental  functions,  etc. ..    113 

CHAPTER    XIV. 
Climatic  periods  and  diagnosis  of  Inebriety. — Study  of 

social  statistics 118 

CHAPTER  XV. 
Delirium  tremens  and  associated  conditions 131 

CHAPTER    XVI. 
General  facts  of  heredity  and  predisposing  conditions.    145 

CHAPTER   XVII. 
Heredity  continued,  views  of  foreign  authors   155 

CHAPTER    XVIII. 
Statistics  of  heredity  and  other  considerations 161 


CONTENTS.  XI U 

CHAPTER  XIX. 

PAGE 

Pathology  and  general  considerations  of  the  nature  of 

Inebriety 173 

CHAPTER  XX. 
Some  of  the  pathological  changes  common  to  all  cases 

of  Inebriety 185 

CHAPTER  XXI 
Treatment,  some  general  considerations  of  the  nature 

and  plan 197 

CHAPTER  XXII. 
Inebriate  Asylums  and  their  nature  and  work 215 

CHAPTER     XXIII. 
Hygiene. — Hot  air  and  other  methods  of   treatment. . .   227 

CHAPTER  XXIV. 
Duty  of  the  State  in  the  care  and  treatment  of  Inebri- 
ates     239 

CHAPTER  XXV. 

Special  care  of  Pauper  Inebriates  in  cities  and  towns..    251 

CHAPTER   XXVI. 
Some  medico-legal  considerations  concerning  Inebriety.  265 

CHAPTER   XXVII. 
Medico-legal  questions  continued,  rulings  of  judges  and 

the  law 277 

CHAPTER  XXVIII. 
General  questions  of  irresponsibility  in  Inebriety 285 


XIV  CONTENTS. 

CHAPTER  XXIX. 

PAGE 

Some  special  forms  of  irresponsibility,  trance,  etc 297 

CHAPTER  XXX. 
Practical  relations  of  inebriety,  coma,  and  brain  dis- 
ease  309 

CHAPTER  XXXI. 
Opium  Inebriety . — Its  nature  and  character 317 

CHAPTER  XXXII. 
Opium  inebriety  continued. — Its  special  treatment..,.  329 

CHAPTER  XXXIII. 
Ether  Inebriety. — Its  origin  and  consequence 347 

CHAPTER   XXXIV. 
Cocaine   Inebriety 357 

CHAPTER  XXXV. 
Chloroform  Inebriety 363 

CHAPTER   XXXVI. 
Inebriety  from  coffee  and  tea,  and  its  effects 369 

CHAPTER  XXXVII 
On  the  psychosis  caused  by  nicotine 377 

CHAPTER  XXXVIII. 
Eau  de  Cologne  drinking. — Arsenic  and  ginger  inebri- 
ety   3^3 


DISEASES  OF  INEBRIETY. 


CHAPTER   I. 

EARLY    HISTORY    OF    DISEASE    THEORY. 

It  is  a  curious  fact  that  inebriety  was  recognized  as  a 
disease  long  before  insanity  was  thought  to  be  othet*  than 
spiritual  madness  and  a  possession  of  the  devil.  The  fact 
has  escaped  the  attention  of  persons  who  assert  that  inebriety 
is  always  a  vice,  and  the  disease  theory  is  only  an  extrava- 
grant  view  of  enthusiasts,  peculiar  to  our  times.  For  over 
a  century,  the  disease  of  insanity  was  denied  and  contested. 
Inebriety  is  passing  the  same  ordeal  of  ignorant  opposition 
and  criticism,  notwithstanding  it  has  been  recognized  by  a 
majority  of  the  leading  physicians  of  the  world  to-day. 

The  following  outlines  of  the  early  history  of  inebri- 
ety will  show  that  this  is  not  a  mere  theory  of  our  times, 
but  a  great  truth,  outlined  and  foreshadowed  by  many  of 
tlie  leading  physicians  and  philosophers  of  the  past. 

This  disease  was  hinted  at  in  an  early  age  of  the  world, 
and  is  by  no  means  a  modern  idea.  On  an  old  papyrus 
found  in  one  of  the  tombs  of  Egypt>  dating  back  to  a  very 
ancient  period,  was  the  following  significant  passage, 
referring  to  an  inebriate  who  had  failed  to  keep  sober  . 

17 


18  DISEASES   OF    INEBRIETY. 

"  Thou  art  like  an  oar  started  from  its  place,  which  is 
unmanageable  every  way  ;  thou  art  like  a  shrine  without  its 
God,  like  a  house  without  provisions,  whose  walls  are  found 
shaky." 

Many  of  the  sculptures  of  Thebes  and  Egypt  exhibit 
inebriates  in  the  act  of  receiving  physical  treatment  from 
their  slaves,  such  as  purgatives,  rubbings  or  applications  to 
the  head  and  spine,  Heroditus,  five  centuries  before  the 
Christian  era,  wrote,  "  that  drunkenness  showed  that  both 
the  body  and  soul  were  sick."  Diodorus  and  Plutarch 
assert  "  that  drink  madness  is  an  affection  of  the  body 
which  hath  destroyed  many  kings  and  noble  people." 
Many  of  tlie  Greek  philosophers  recognized  the  physical 
character  of  inebriety  and  the  hereditary  influence  or  tend- 
encies which  were  transmitted  to  the  next  generation. 

Laws  were  enacted  forbidding  women  to  use  wine,  and 
young  boys  were  restricted. 

Frequent  reference  is  made  to  the  madness  which 
souglit  solace  in  wine  and  spirits.  Such  cases  are  called 
and  urged  to  give  more  diligent  care  to  their  bodies,  a 
distinct  hint  of  the  physical  origin  of  inebriety. 

In  the  first  century  of  the  Christian  era,  St.  John 
Clirysostom  urged  that  inebriety  was  a  disease  like  dys- 
pepsia, and  illustrated  his  meaning  by  many  quaint  reason- 
ings. This  was  the  first  clear,  distinctive  recognization  of 
the  disease,  which  had  been  hinted  at  long  before. 

In  the  next  century,  Ulpian,  the  Roman  jurist,  referred 
to  the  irresponsible  character  of  inebriates,  and  the 
necessity  of  treating  them  as  sick  men.  His  views  were 
embodied  in  some  laws,  which  referred  more  distinctly  to 
the  physical  nature  and  treatment  of  inebriety. 

Many  of  the  early  and  later  writers  of  Roman  civiliza- 
tion contain  references  to  drunkenness  as  a  bodily  disorder, 
not  controllable  beyond  a  certain  point,  which  resulted  in 
veritable  madness.  Nothing  more  was  heard  of  this  theory 
until    the    thirteenth   century,  when    one   of  the    Kings    of 


EAELT    HISTORY   OF   DISEASE   THEOKY.  19 

Spain  enacted  laws  fully  recognizing  inebriety  as  a  disease, 
lessening  the  punishment  of  crime  committed  when  under 
the  influence  of  spirits.  One  of  the  laws  provided,  that 
when  murder  was  committed  during  intoxication,  the  death 
penalty  should  be  remitted,  and  the  prisoner  be  banished 
to  some  island  for  a  period  of  not  less  than  six  years. 

In  the  sixteenth  century  the  penal  codes  of  France  and 
many  of  the  German  States  contained  enactments  which 
recognized  the  disease  character  of  inebriety. 

All  punishment  for  crime  committed  during  this  State 
varied  according  to  the  conditions  of  the  prisoner  at  the 
time. 

Drunkenness,  continued  beyond  a  certain  point,  was 
regarded  as  a  condition  of  insanity  and  irresponsibility. 
In  many  of  the  medical  writings  of  these  ages,  drunken- 
ness and  madness  were  mentioned  as  synonyms,  and  curious 
reflections  on  the  nature  and  treatment  of  the  evil  are 
detailed. 

In  1747,  Condillac,  a  French  philosopher,  wrote  express- 
ing clear  views  of  the  disease  of  inebriety,  also  that  the 
State  should  recognize  and  provide  means  for  its  treatment. 
He  asserted  that  the  impulse  to  drink  was  like  insanity, 
an  affection  of  the  brain,  which  could  not  be  reached  by  law 
or  religion. 

Dr.  Benjamin  Rush,  of  Philadelphia,  in  1790,  set  forth 
the  same  theory,  supported  by  a  long  train  of  reasoning. 
To  him  belongs  the  honor  of  first  elaborating  this  sub- 
ject and  outlining  what  has  been  accepted  half  a  century 
after. 

In  two  essays,  entitled,  "  The  influences  of  physical  causes 
upon  moral  faculties,"  and  "An  inquiry  into  the  effects  of 
ardent  spirits  upon  the  human  body  and  mind,"  he  described 
the  disease  of  inebriety,  dividing  it  into  acute  and  chronic 
forms,  giving  many  of  the  causes,  of  which  heredity  was 
prominent,  also  urging  that  special  measures  be  taken  in 
the  treatment,  which  should  be  in  a   hospital  for  this  pur- 


20  DISEASES    OF   INEBRIETY. 

pose.  Up  to  tliis  time  these  views  were  clear  and  distinct- 
ive, althougli  not  published  until  1809.  They  were  entirely 
independent  of  all  previous  observations. 

In  1802,  Dr.  Cabanis,  of  Paris,  wrote  fully  indorsing  the 
views  of  Condillac,  that  inebriety,  like  insanity,  was  a  disease 
which  should  be  studied,  and  that  it  was  a  distinct  form  of 
mental  disorder,  needing  medical  care  and  treatment.  Pro- 
fessor Plainer,  of  Leipsig,  published  a  paper  in  1809  (the 
same  year  Rush's  writings  appeared),  affirming  that  ine- 
briety was  like  an  insane  impulse  and  a  form  of  insanity 
which  should  receive  medical  care  and  be  studied  by  the 
aid  of  science. 

In  1817,  Salvator,  of  Moscow,  a  physician  of  some  emin- 
ence, published  a  pamphlet  called  "  Ebriosity,  its  pathology 
and  treatment."  He  divided  drunkenness  into  two  forms, 
intermittent  and  remittent,  and  urged  that  they  be  treated 
by  physical  means. 

Esquirol,  in  1818,  described  a  condition  of  the  nervous 
system  in  which  inebriety  was  sure  to  follow.  In  1822,  Buhl 
Cramner,  a  distinguished  physician  of  Berlin,  wrote  a  small 
book  defining  inebriety  as  a  state  of  irritation  of  the  brain 
and  nervous  system,  to  be  cured  by  physical  means  because 
it  was  purely  of  physical  origin. 

In  Europe  the  writings  of  these  four  men,  Platner,  Sal- 
vator, Esquirol  and  Cramner,  placed  the  subject  on  a  scien- 
tific basis,  paving  the  way  for  a  wider  and  more  thorough 
study.  Although  Dr.  Rush  had  written  on  the  general 
subject  more  definitely  than  the  others,  his  writings  were 
practically  unknown. 

In  1830,  a  committee  of  the  Connecticut  State  Medical 
Society,  appointed  the  year  before  to  report  on  the  necessity 
of  an  asylum  for  the  medical  care  and  treatment  of  inebri- 
ates, recommended  in  an  elaborate  essay  that  it  was  expedi- 
ent to  establish  an  asylum  for  the  cure  of  inebriates. 

This  report,  written  by  Dr.  Todd,  the  superintendent  of 


EARLY    HISTOKY    OF   DISEASE    THEORY.  21 

the  insane  asylum,  strongly  urged  the  recognition  of  the 
disease  of  inebriety  and  its  curability  by  physical  means. 

Tliis  report,  wliich  may  be  found  in  the  Transactions  of 
the  Conn.  State  Medical  Society,  was  a  remarkable  concep- 
tion of  the  subject,  far  beyond  the  current  opinions  of  that 
time,  only  now  beginning  to  be  recognized. 

In  1833,  Dr.  Woodard,  of  Worcester,  Mass.,  urged  that 
inebriety  was  a  disease,  and  curable  as  other  diseases  in 
asylums  for  this  purpose.  This  attracted  attention  and 
was  endorsed  by  many.  In  1839,  Dr.  Roesch,  of  Tubingen, 
in  a  volume  on  spirituous  liquors,  urged  that  inebriety  be 
considered  a  disease.  He  elaborated  the  idea  and  pointed 
out  the  errors  of  other  authors  at  some  length. 

Dr.  Nasse,  of  Bonn,  followed,  urging  the  same  view. 

From  this  date,  the  literature  has  grown  rapidly,  especi- 
ally in  this  country.  The  opinions  and  writings  of  Ameri- 
can physicians  on  this  subject  are  now  widely  sought  for  in 
Europe.  The  English  Lunacy  Commission,  in  1844,  urged 
that  inebriates  should  be  regarded  as  insane,  sent  to  asylums 
for  treatment,  and  not  punished  as  before. 

Many  other  writers  timidly  followed  these  advanced 
theories  and,  when  stoutly  opposed,  compromised  by  admit- 
ting a  state  of  half  disease  and  half  vice. 


CHAPTER  IT. 

HISTORY   OF   DISEASE   THEORY   IN    MODERN   TIMES. 

The  Washingtonian  temperance  revival,  of  1840,  seemed 
to  have  cleared  away  man}'-  of  the  old  theories  and  prejudices, 
and  gave  clearer  conceptions  of  the  real  nature  and  charac- 
ter of  inebriety.  The  sudden  and  intense  projection  of  the 
moral  side  of  inebriety  reacted  when  this  reform  wave 
died  away,  but  it  had  served  to  fuse  and  mobilize  the  tide 
of  oncoming  truth,  outlined  for  a  long  time  in  frequent 
statements  of  the  disease  of  inebriety.  The  first  practical 
demonstration  of  this  began  in  a  lodging-house  for  in- 
ebriates, opened  in  1845,  at  Boston,  Mass.,  called  the  Wash- 
ingtonian Hall.  This  recognized,  in  a  crude  way,  the  phys- 
ical disabilities  of  inebriates,  and  souglit  to  remove  them 
by  physical  means.  This  was  tiie  first  embrio  asylum  of  the 
world,  which  has  grown  into  the  Washingtonian  Home  of 
the  present  da3\ 

While  physicians  and  writers  were  repeating  the  theories 
of  the  possibility  of  disease  of  inebriety,  Dr.  J.  Edward 
Turner,  a  Maine  physician, came  forward  as  the  great  pion- 
eer to  vitalize  and  show  the  practical  value  of  the  truth  that 
inebriety  was  a  disease,  and  curable. 

In  1846,  Dr.  Turner  became  interested  in  this  work  from 
an  ineffectual  effort  to  save  an  early  friend  who  was  an 
inebriate.  He  recognized  the  nature  of  the  disease  of 
inebriety  and  the  need  of  hospital  treatment,  and  began  an 
enthusiastic  agitation  of  the  subject.  After  eight  years  of 
most  persistent  effort,  in  the  face  of  great  opposition,  he 
succeeded  in  enlisting  the  attention  of  many  eminent  medi- 

23 


HISTORY    OF   DISEASE    THEORY    IN    MODERN    TIMES  23 

cal  men,  and  in  forming  a  company  to  build  an  Inebriate 
Hospital,  witli  the  late  famous  surgeon,  Dr.  Valentine  Mott, 
as  president.  Laws  were  passed  to  give  power  to  hold 
inmates,  a  charter  was  granted,  and  nearly  fifty  thousand 
dollars  subscribed  for  tlie  grounds  and  building.  Ten 
years  later,  in  1864,  a  magnificent  building  was  completed 
and  opened  for  patients,  at  Binghampton,  N.  Y.,  the  pioneer 
hospital  of  the  world.  Later,  a  fire  destroyed  part  of  the 
building,  which  was  soon  after  rebuilt.  Then  the  board  of 
trustees  became  involved  in  a  controversy  with  the  founder, 
Dr.  Turner,  resulting  in  his  retirement,  and  placing  the 
hospital  in  the  care  of  the  State.  Passing  into  the  manage- 
ment of  politicians,  its  history  was  a  series  of  misfortunes, 
until  finally  it  was  changed  into  a  chronic  insane  asylum. 
Thus  Dr.  Turner,  the  founder,  who  had  conceived  and  built 
this  hospital,  giving  over  a  quarter  of  a  century  of  time  and 
effort,  and  his  own  personal  fortune,  shared  the  fate  of  all 
reformers  and  benefactors  of  the  world,  in  the  obloquy  and 
disgrace  of  being  driven  away  from  the  creation  of  his  own 
genius. 

The  New  York  State  Inebriate  Asylum  was  the  first 
institution  of  the  kind  ever  organized.  After  fourteen 
years  of  a  most  extraordinary  history,  it  was  closed  and 
converted  into  an  insane  asylum.  The  same  old  battle  has 
been  waged  around  and  about  this  institution  with  which 
every  new  truth  of  science  has  had  to  contend.  Bitter 
skeptics  and  foolish  enthusiasts  have  rushed  to  conclusions 
in  regard  to  his  work,  which  could  only  be  determined  by 
a  century  of  accurate  study  and  observation.  Literally,  this 
pioneer  asylum  has  been  the  great  "  On  to  Richmond" 
movement,  checked  by  a  Bull  Run  disaster.  During  the 
fourteen  years  of  its  existence,  two  thousand  three  hundred 
and  forty-four  inebriates  weie  under  treatment.  A  vast 
majority  of  these  were  the  most  chronic  cases. 

The  enthusiasm  wliich  at  first  centered  about  Binghamp- 
ton  Hospital   reacted,   and    the  moralists   and   temperance 


24  DISEASES    OF    INEBRIETY. 

advocates,  who  from  tlie  first  liad  opposed  tliis  movement 
as  an  "  infidel  work  "  to  diminish  human  responsibility, 
used  every  means  to  spread  the  idea  of  failure  and  condemn 
other  efforts  in  this  direction.  But  a  great  fact  had  been 
recognized,  and  its  practical  character  had  taken  deep  root 
in  the  public  mind.  The  birth  of  the  Binghampton  Hospital 
was  followed  by  the  organization  of  over  a  dozen  different 
hospitals  for  this  work  in  different  parts  of  tlie  country, 
some  of  which  are  still  in  existence,  doing  grand  work. 

Notwithstanding  the  misfortunes  of  the  first  hospital 
and  its  founder,  a  large  number  of  similar  places  have  been 
organized  and  managed  with  success.  As  in  all  new  enter- 
prises, many  of  these  hospitals  must  suffer  from  non-expert 
management,  and  be  organized  on  some  theory  of  the 
nature  and  treatment  of  inebriety  not  founded  in  correct 
study  and  experience.  After  a  time  they  are  abandoned 
or  changed  to  homes  for  nervous  and  insane  cases.  Over 
fifty  different  hospitals  for  inebriates  have  been  established 
in  America.  More  tlian  thirty  of  this  number  are  in  suc- 
cessful operation  ;  the  others  have  changed  into  insane 
asylums,  water-cures,  etc.  Tiiree  large  buildings  or  insti- 
tutions are  practically  "  faith  cures,"  wiiere  all  physical 
remedies  and  means  are  ignored.  Several  asylums  are 
called  homes  for  nervous  people,  to  conceal  the  real  cause, 
and  thus  protect  the  patients  from  the  supposed  stigma  of 
inebriety.  Others  are  literally  lodging-liouses,  where  the 
inmates  can  remain  a  few  days  and  recover  from  the  effects 
of  spirits.  Several  places  make  a  specialty  of  opium  cases  ; 
in  some  the  treatment  is  often  empirical.  In  only  a  few  of 
these  hospitals  is  inebriety  studied  and  treated  on  a  scien- 
tific basis.  The  others  are  passing  through  the  ordeal  of 
"elimination  and  survival  of  the  fittest,"  incident  to  every 
new  advance  of  science.  In  many  of  the  States  large  pub- 
lic hospitals  are  projected,  and  are  awaiting  pecuniary  aid 
from  the  State  or  from  other  sources. 

Most  of  the  inebriate  hospitals    in   America  are  private 


HISTORY    OF   DISEASE   THEORY   IN   MODERN   TIMES.  25 

and  corporate  organizations,  wliich  receive,  from  time  to 
time,  State  aid.  Some  of  them  have  endowments,  such  as 
free  beds,  or  incomes  from  estates,  or  are  given  so  much  of 
tlie  license  money.  Others  depend  upon  the  income  from 
patients,  private  donation,  and  charities  generally.  Very 
few  paupers  or  indigent  poor  are  received  in  any  of  these 
hospitals.  This  class  appear  in  the  "lodging"  and  "  faith- 
cure  "  places.  The  State  of  Connecticut  has  projected  a 
workhouse  hospital  for  the  criminal  class  of  these  cases, 
where  the  commitment  is  for  three  years,  but  want  of  State 
aid  has  prevented  practical  work  so  far.  In  three  other 
States  similar  projects  for  the  pauper  inebriates  have  been 
organized,  but  for  various  reasons  have  not  gone  into  oper- 
ation. 

In  Europe,  over  sixty  hospitals  for  the  physical  care  and 
treatment  of  inebriates  are  in  active  operation  to-day.  There 
are  two  in  Australia,  one  in  China,  two  in  India,  one  in 
Ceylon,  three  in  Africa,  and  one  in  Mexico.  While  these 
institutions  vary  widely  in  plan  and  methods,  the  central  idea 
is  the  physical  treatment  of  the  inebriate  and  his  malady. 

The  literature  of  this  subject  has  grown  to  enormous 
proportions,  principally  in  papers,  lectures  and  pamphlets. 

The  exact  scientific  study  of  inebriety  has  revealed  facts 
and  conclusions  which  have  aroused  bitter  controversy  from 
those  who  should  have  been  first  to  welcome  its  truths. 

A  large  number  of  so-called  reformers  have  been  from 
the  first  denouncers  of  the  disease  theory,  but  unwittingly 
they  have  greatly  helped  on  the  work  by  controversy  and 
agitation.  In  1870,  an  association  was  formed  of  persons  who 
were  connected  with  inebriate  asylums,  or  interested  in  the 
subject,  called' the  American  Association  for  the  Study  and 
Cure  of  Inebriates.  This  Association  has  since  met  yearly  and 
semi-yearly  ;  its  papers  and  transactions  comprise  the  first 
permanent  literature  on  this  subject.  In  1877,  the  Journal 
of  Inebriety  was  issued  as  the  organ  of  this  association,  and 
from  that  time  has  been  the  medium  through  which  most 


26  DISEASES     OF   INEBRIETY. 

of  the  literature  of  the  subject  from  America  has  been  pre- 
sented. Inebriety,  and  its  curability  in  special  hospitals, 
has  been  the  cardinal  principle  of  this  Association,  which  it 
has  demonstrated  and  maintained  with  increasing  vigor. 
Discussing  exclusively  the  physical  side  of  this  subject, 
amid  difficulties  which  only  pioneers  in  a  new  field  have  to 
contend  with,  tlie  foundation  of  a  scientific  literature  has 
been  laid  which  will  be  historic  to  future  students  of  this 
subject.  This  Association  and  its  journal  are  great  silent 
powers,  crystallizing  and  marshaling  the  many  facts  con- 
stantl}'^  appearing  from  a  study  of  tliese  cases.  Already  sev- 
eral members  of  this  Association  liave  publislied  works  on 
inebriety  that  mark  the  beginning  of  a  "  new  era,"  and  have 
given  great  impetus  to  its  scientific  study. 

In  1884,  a  similar  society  was  formed  in  England,  called 
the  Society  for  the  study  and  cure  of  Inebriety.  Similar 
societies  have  been  formed  in  France,  Switzerland,  Germany 
and  Sweden. 

In  1887,  an  International  Congress  was  held  in  London 
for  the  discussion  of  the  disease  of  inebriety.  Delegates 
from  all  the  world  were  present. 

Numerous  committees,  scientific  and  legislative,  have 
made  elaborative  reports  on  the  disease  of  inebriety  and 
the  means  and  measures  for  its  prevention  and  treatment. 


CHAPTER  III. 

INEBRIETY  :   ITS   CLASSIFICATION   AND   FORMS. 

This  term  more  accurate!}'  represents  the  general 
phenomena  called  diunkenness  tlian  any  other.  There  are 
two  great  classes,  which  may  be  designated  Inebriates  and 
Dipsomaniacs. 

The  first  class,  when  studied  collectively,  seem  to  divide 
into  several  classes  from  different  causes  witli  different 
symptoms  and  termination.  One  of  these  classes  are  the 
accidental  idebriates,  persons  whose  use  of  spirits  are  depend- 
ent entirely  on  external  conditions  and  environment. 
They  seem  to  possess  a  high  degree  of  brain  and  nerve 
instability,  and  have  small  resisting  power,  or  capacity  to 
adapt  themselves  to  new  surroundings  and  conditions  of 
life,  and  retain  any  fixed  individuality.  Such  persons  drink 
or  abstain  according  to  the  company  they  are  associated 
with.  They  are  enthusiastic  temperance  reformers,  or 
abject  drunkards,  from  the  mere  contagion  of  surround- 
ings. In  a  prohibition  community,  they  are  models  of 
sobriety,  or  types  of  the  lowest  drinkers  where  spirits  are 
free.  Their  progress  and  future  turn  altogether  on 
environment. 

A  second  class  of  these  accidental  inebriates  are  con- 
trolled solely  by  functional  disturbances  of  the  body. 
Spirits  are  never  used  except  when  some  derangement  of 
tlie  organism  occurs.  Attacks  of  indigestion,  chills,  over- 
work, and  all  forms  of  minor  strains  or  drains,  lead  up 
quickly  to  the  use  of  spirits,  without  reason  or  premedita- 
tion.    After  the  sedative  action  of  alcohol  has  taken  place  a 

27 


28  DISEASES   OF    INEBRIETY. 

few    times,    the    internal    resisting    force    is    permanently 
broken  up  and  tlie  person  drinks  ever  after. 

A  second  group  may  be  called  emotional  inebriates.  They 
belong  to  that  class  who  are  always  on  the  borders  of 
hysteria,  with  feeble  and  unstable  will.  Wayward,  selfish, 
fitful,  uncertain,  out  of  harmony  with  every  relation  of 
life  ;  all  the  time  suffering  from  a  constitutional  unrest, 
and  emotional  struggles  to  attain  the  impossible.  Spirits 
afford  relief  for  this  physical  state,  and  are  alternately 
used  and  abandoned  until  death  or  insanity  comes  on. 

Another  class,  called  solitaiy  inebriates,  use  spirits  only  at 
night  or  alone,  and  seem  morbidly  sensitive  to  conceal  this 
fact.  They  always  deny  all  use  of  spirits,  and  display  great 
cunning  and  tact  to  cover  up  this  condition.  Tiieir  drink- 
ing seems  often  to  be  under  control  of  the  morbid  reason, 
and  is  checked  at  certain  times,  and  is  limited  b)'  con- 
ditions and  circumstances.  These  are  the  most  interesting 
of  all  cases,  and  often  appear  in  persons  who  occupy 
responsible  positions,  and  involve  very  important  ques- 
tions of  business  and  science. 

.  A  large  class  of  inebriates,  appearing  in  lower  levels  of 
life,  are  found  to  be  literally  constitutional  paupers,  who 
through  heredity  and  environment  are  switched  off  on  the 
side-track  of  dissolution.  They  may  be  termed  the 
pauper  inebriates,  and  are  persons  with  special  unfitness  for 
healthy  life,  who  are  by  the  higher  processes  of  nature 
crowded  out  in  the  race  struggle.  Inebriety  is  simply 
another  symptom  of  this  condition.  The  subsidence  of 
the  drink  craze  is  followed  by  other  degrees  of  degener- 
ation. Criminality,  pauperism,  prostitution,  are  all  allied 
conditions.  Many  other  sub-classes  of  inebriety  are  found, 
but  they  all  date  from  some  condition  of  brain  and  nerve 
degeneration,  and  although  the  symptoms  may  vary,  the 
line  of  progress  and  growth  are  practically  the  same. 


CHAPTER    IV. 

DIPSOMANIA  :    ITS  HISTORY  AND  RELATION. 

Dipsomania  is  a  term  used  to  designate  a  large  class  of 
inebriates,  in  which  the  drink  impulse  comes  on  suddenly 
and  after  a  time  dies  out,  and  is  succeeded  by  a  free  inter- 
val. This  has  been  truly  termed  a  neurosis,  which  is  prac- 
tically another  branch  of  the  same  family  of  epileptics, 
insane  hysterias  and  paranoic. 

There  are  three  principal  forms  :  First,  the  acute,  which 
is  not  very  common,  wliere  the  drink  craze  comes  on  sud- 
denly from  hemorrhage  sunstroke  ;  and  also  convalescence 
from  fevers,  excessive  strains,  as  continuous  overwork,  with 
mental  care  and  excitement,  and  also  severe  drains  of  the 
nerve  energy,  exhaustion  and  other  causes. 

This  variety  seems  to  resemble  an  attack  of  mania  in  its 
violence  and  uncontrollability,  and  good  evidence  of  dipso- 
mania being  an  insanity  and  requiring  careful  watching  and 
treatment. 

Th^  periodic  is  a  more  common  variety.  By  some  authors 
it  is  considered  the  most  common  form,  but  in  our  expe- 
rience the  chronic  is  more  frequent.  In  this  variety  are 
classed  those  patients  who  have  periodic  attacks  of  drinking 
lasting  for  a  long  or  sliort  period.  In  some  patients  the 
attack  comes  on  suddenly.  That  is  to  say,  they  take 
to  drinking  laige  quantities  of  alcoholic  fluids  without 
any  premonitory  symptom.  But  more  often  there  is 
noticed  an  alteration  in  character  and  temper  that  fore- 
warns those  who  have  anything  to  do  with  the  patient.  In 
the  case  of  a  married  man,  the  wife  can  almost  always  tell 

29 


30  DISEASES    OF   INEBRIETY. 

when  an  attack  is  coming  on.  The  length  of  these  attacks 
vary  greatly,  more  especially  according  to  the  duration 
of  the  disease  in  the  patient.  In  the  early  history  of  tlie 
disease,  the  drinking  bouts  often  last  from  one  to  three 
weeks,  and  during  that  time  the  patient  is  constantly 
drinking.  When  he  cannot  get  the  quantities  of  liquor 
that  he  requiries  outside,  he  takes  to  diinking  in  his  own 
rooms  or  house.  Nothing  will  stop  him.  If  his  friends  or 
servants  try  to  get  him  to  leave  off,  he  storms  and  rages, 
and  terrifies  tliem  into  submission  to  his  ways  and  wants. 
His  excuse  for  drinking  is  always  that  he  is  excessively 
weak  and  nervous  and  requires  support,  and  that  it  is  abso- 
lutely necessary  for  his  life  that  he  should  have  stimulants. 
His  appetite  soon  disappears,  and  he  only  makes  vain 
efforts  to  partake  of  any  food  tliat  is  brought  to  him. 
Great  sleeplessness  and  restlessness  comes  on,  and  in  fact, 
the  patient  is  often  on  the  verge  of  delirium  tremens  when 
the  disease  abates  either  gradually  or  suddenly,  and  he  gets 
fairly  well.  When  it  ends  suddenly,  it  is  from  an  attack  of 
acute  or  subacute  gastritis,  for  which  he  requires  and  seeks 
medical  aid.  The  craving  for  drink  having  also  disap- 
peared, he  willingly  submits  to  medical  direction,  and  under 
judicious  treatment,  recovers.  When  the  attacks  go  off 
gradually  there  are  less  severe  gastric  symptoms,  and  the 
craving  having  become  less,  tliere  is  a  diminution  in  the 
gastric  and  nervous  troubles. 

After  patients  have  lived  for  several  years  with  these 
periodical  attacks,  the  duration  of  attack  diminishes  in 
length,  and  they  increase  in  frequency  ;  the  cause  of  this 
being  chiefly  due  to  the  effects  on  the  gastric  system.  The 
stomach  much  sooner  resents  the  large  quantities  of  alcohol 
put  into  it,  and  consequently  the  drinking  fits  are  cut  short 
by  attacks  of  gastritis,  and  often  also  enteritis.  But  from 
the  attack  being  shoiler,  the  interval  of  diminution  in  drink- 
ing also  becomes  shorter,  so  that  tlie  patient  gradually  goes 
on  from  bad  to  worse.     Once  the  drinking  fit  passes  ofi,  the 


DIPSOMANIA  :      ITS    HISTORY    AND   RELATION.  31 

patient  generally  expresses  great  horror  and  grief  at  his 
propensity  and  the  effects  it  produces,  and  will  make  all 
sorts  of  promises  to  abstain  altogether  from  alcholic  drinks. 
If  the  case  is  not  a  severe  one,  and  the  moral  surroundings 
of  the  patient  are  good,  he  will  often  keep  his  resolution 
for  a  long  period.  But  eventually,  from  some  cause,  either 
of  social  temptation  or  mental  worry,  he  again  breaks 
out  and  becomes  wholly  ungovernable.  We  have  known 
cases  where  a  man  having  recovered  from  a  periodic  attack 
would  go  for  a  period  of  from  four  to  eigiit  months  without 
drinking  any  alcoholic  liquor,  but  the  first  taste  of  liquor 
after  that  abstinence  would  bring  on  an  attack. 

A  great  many  cases  are  called  periodic  which  are  really 
chronic,  but  with  temporary  exacerbations,  and  we  will  dis- 
cuss these  under  the  chronic  variety.  We  only  include 
under  the  periodic  those  cases  where  there  are  complete 
periods  of  a  natural  condition  of  mind  and  body  ;  and  in 
almost  all  these  the  patients  are  either  total  abstainers  or 
extremely  careful  and  temperate  in  their  habits  in  the 
intervals  between  the  drinking  fits.  The  higher  tlie  moral 
nature  of  the  patient,  the  longer  are  those  tranquil  intervals, 
but  the  lower  the  moral  nature  the  shorter  are  those  periods. 
The  reason  being  that  a  man  of  high  moral  nature,  either 
from  culture  or  inherent  preception,  gets  more  control  over 
himself  and  will  battle  long  against  the  craving  when  it  is 
coming  on,  although  eventually  he  gives  way  not  from  any 
fault  of  his  own,  but  on  account  of  his  being  the  subject  of 
a  mental  disease  entirely  beyond  his  control.  On  the  other 
hand,  a  man  of  low  moral  standing  will  never  try  to  keep 
himself  from  the  temptations  that  he  knows  are  dangerous 
for  him,  and  never  makes  any  attempt  to  stave  off  the  crav- 
ing, but  yields  at  once.  These  last  are  a  much  more  hope- 
less set  of  cases  to  deal  with,  and  are  almost  always  incur- 
able, and  eventually  die  from  accidents  or  diseases  induced 
by  their  habits. 

Dipsomania  that  comes  on  from  injury  to  the   head  is 


32  DISEASES    OF   INEBRIETY. 

generally  of  the  periodic  variety.  Blows  or  falls  on  the 
head  are  followed  at  a  long  or  short  period  afterward  by 
periodic  attacks  of  drinking  mania.  In  surgical  and  medical 
practice  it  is  well  known  that  similar  blows  on  tlie  head  are 
not  infrequently  followed  by  epileptic  fits,  and  both  these 
classes  of  cases,  viz.,  the  accession  of  periodic  attacks  of 
dipsomania  after  injuries,  and  the  periodic  attacks  of  which 
we  have  been  treating  at  length  above,  tend  to  point  to  a 
relation  between  epilepsy  and  dipsomania.  Just  as  an  injury 
to  the  head  by  producing  some  alteration  in  the  nerve- 
centers  brings  on  epilepsy,  so  do  they  at  other  times  bring 
on  dipsomania  by  no  doubt  causing  also  some  alteration  in 
the  nervous  tissues.  Again,  where  there  is  insanity  in  a 
family,  in  the  progeny  there  is  a  great  liability  to  a  repetition 
of  that  same  condition  of  the  nerve-centers  which  produces 
insanity,  or  else  some  modification  of  it,  such  as  epilepsy  or 
dipsomania,  for  in  almost  every  case  of  periodic  dipso- 
mania is  there  to  be  found  a  history  of  nervous  affections. 
There  are  cases  on  record  of  transitions  between  these  two 
affections.  Either  an  attack  of  drinking  passing  off  by  an 
epileptic  fit,  or  patients  at  one  time  having  an  attack  of 
epilepsy  and  at  another  time  an  attack  of  craving  for  drink. 
In  fact,  the  two  affections  are  very  much  alike  in  many 
ways.  Judging  from  cases  under  observation,  the  periodic 
variety  seems  hardly  ever  to  be  induced  by  acquired  habits 
of  drinking  alcohol,  it  being  almost  always  the  result  of 
strong  hereditary  tendency  to  neurosis  of  some  kind.  Our 
object  in  laying  such  stress  upon  the  real  insanity  of  dipso- 
mania is  to  get  its  recognition  as  such  by  the  legislature. 

We  stated  just  now  the  difference  in  effect  upon  the 
course  of  dipsomania  caused  by  the  presence  of  more  or 
less  high  moral  nature  in  the  patient.  All  those  who  have 
studied  insanity  have  come  to  the  conclusion  that  very 
often  there  is  a  complete  absence  of  the  moral  nature — 
patients  not  having  the  slightest  conception  of  any  moral 
obligations   due    to   their   fellow   beings     or    themselves. 


DIPSOMANIA  :      ITS    HISTORl    AND    RELATION.  33 

Very  frequenth'^,  among  dipsomanics,  is  there  this  complete 
absence  of  any  morality. 

It  is  not  often  recognized.  Friends  and  acquaintances 
of  the  patient  accuse  him  or  her  of  immorality  unjustly. 
For  a  man  cannot  be  immoral  who  has  no  ideas  of  morality 
to  start  with.  Many  will  think  such  a  state  of  tilings 
incredible,  but  it  is  really  not  so.  Patients  suffering  from 
dipsomania  often  behave  very  well  for  a  time,  but  it  is  only 
from  the  effects  of  habit  from  the  way  they  have  been 
brought  up.  They  may  do  what  is  right,  and  often  appear 
to  go  out  of  their  way  to  do  what  is  right,  but  if  one  could 
get  at  the  root  of  their  actions,  it  would  be  found  that  they 
were  not  guided  by  any  moral  feeling  or  sense  whatever. 

Dipsomaniacs  show  this  perversion,  or  rather,  absence 
of  morals,  in  almost  all  their  dealings  with  tlieir  friends 
and  relations,  and  it  is  on  this  account  that  the  disease  is 
such  a  scourge  to  the  friends  and  relatives.  The  patient 
will  give  the  most  solemn  promises  not  to  take  any  stimu- 
lant, but  the  backs  of  those  to  whom  he  has  made  the 
promise  are  no  sooner  turned  than  he  violates  it,  either  by 
obtaining  the  liquor  himself  or  not  refusing  the  first  or  any 
temptation  that  is  set  before  him.  They  always  have  a 
plausible  excuse  when  taxed  with  their  violation  of  promise. 
They  will  also  prevaricate  most  cunningly  until  the  ques- 
tion is  put  directly  to  them.  It  is  curious  that  in  spite  of 
the  absence  of  moral  nature  they  will  rarely  tell  a  deliber- 
ate lie.  Some  people  might  think  this  was  due  to  a  vestige 
of  morality,  but  it  is,  we  think,  due  simply  to  a  knowledge 
of  their  weakness,  and  to  the  power  exercised  by  a  stronger 
mind  over  theirs.  This  habit  of  prevarication,  of  never 
giving  the  lie  direct,  they  are  cunning  enough  to  bring  for- 
ward as  a  plea  for  tlieir  being  trusted  occasionally.  But  in 
our  opinion,  a  dipsomaniac  can  never  be  trusted.  It  is  not 
right  that  he  should  be  led  to  suppose  so,  for  that  would  do 
iiim  inevitable  harm,  as  we  shall  see  presently  in  discussing 
moral   treatment   for    dipsomania,  but    at    the    same    time 


34  DISEASES   OF   INEBRIETY. 

one  would  never  rely  on  the  promises  given  by  a  dipso- 
maniac, more  especially  if  it  is  in  regard  to  taking  any  pre- 
cautions for  guarding  against  his  propensity. 

As  regards  the  recurrence  of  these  periodic  attacks, 
they  do  not  seem  to  have  any  regular  intervals.  In  some 
patients  there  is  a  cessation  of  the  drinking  propensity  for 
many  montlis,  in  others,  only  for  a  few  weeks.  In  the 
chronic  variety  we  shall  have  to  mention  that  where  periodic 
exacerbations  occur,  they  often  do  so  at  regular  intervals, 
and  the  length  of  time  is  generally  a  month. 

In  women,  where  generative  functions  are  periodic,  dip- 
somania, like  other  varieties  of  insanity  in  women,  is  apt  to 
recur  at  intervals  corresponding  to  the  menstrual  periods. 

The  progress,  tlien,  of  periodic  dipsomania  is  generally 
an  increasing  frequency  of  the  recurrence  of  the  attacks 
which  may  verge  into  the  chronic  variety,  but  as  often  as 
not  kills  the  patient  before  tiiat  stage  is   reached. 

Among  this  class,  however,  are  found  some  who  do 
appear  to  be  cured  by  careful  and  judicious  treatment 
during  the  intervals.  The  treatment  consisting  in  eleva- 
ting the  moral  nature  by  every  possible  means,  improv- 
ing the  patient's  general  health,  and  getting  him  to  employ 
his  mind  and  body  actively.  Tiiere  is  one  drug  which 
ought  to  have  extensive  trial  for  treating  the  periodic 
attacks.  Bromide  of  potassium  is  well  known  to  be  of 
great  service  in  reducing  the  frequency  and  force  of  epi- 
leptic attacks,  and  seeing  the  close  relationship  of  dip- 
somania to  epileps}'',  it  ought  to  be  of  use.  We  have  not 
had  the  chance  of  giving  it  much  trial  in  the  periodic 
varieties,  but  in  the  chronic  it  is  of  immense  service. 

In  those  cases  where  the  moral  nature  is  evidently  low, 
weak,  or  absent,  no  hope  can  be  held  out  for  cure,  and 
the  patients  will  be  an  endless  source  of  misery  to  them- 
selves and  relatives  till  they  die.  It  is  for  these  cases  that 
a  proper  law  is  so  much  required.  During  tiie  attacks 
nothing  but  restraint  can  keep  them  from  liquor. 


dipsomania:    its  history  and  relation.  35 

Men  who  suffer  from  periodic  attacks  live  a  little  longer 
than  those  whose  attacks  are  chronic  in  their  nature. 
Among  women  the  periodic  is  more  common  during  the 
whole  of  the  time  of  the  existence  of  the  generative  func- 
tions. Chronic  dipsomania  in  women  more  often  comes 
on  later  in  life. 

Chronic  Dipsomania. — We  are  certain  that  this  is  the  most 
common  form.  Those  suffering  from  it  generally  commence 
drinking  at  an  early  age,  usually  17  or  18,  and  by  30  years 
of  age  most  of  them  have  died.  They  die  either  from 
the  direct  effects  of  the  drink  they  are  continually  consum- 
ing, or  else  from  diseases  induced  by  it,  such  as  absolute 
insanity  or  diseases  of  liver  artd  kidneys.  The  disease  is 
not  generally  recognized  in  the  first  few  years  of  its  course, 
as  the  patient's  friends  and  relatives  merely  suppose  him  to 
be  living  a  little  too  fast,  and  that  he  will  pull  up  soon. 
However,  after  a  few  years  it  is  found  that  he  is  never  really 
free  from  the  effects  of  liquor.  He  is  hardly  ever  really 
drunk,  but  is  never  sober.  As  we  have  said  before,  cham- 
pagne is  the  usual  drink  during  the  first  years  of  a  dipso- 
maniac's career.  When  he  takes  more  than  enough,  it  shows 
its  effects  by  making  him  very  sleepy,  and  he  will  lie  down 
at  the  most  unusual  times  and  places,  and  fall  off  into  an 
apparent  dead  sleep,  from  which  it  is  very  difficult  to  awake 
him,  and  if  one  does  so,  he  usually  manifests  a  disgusting 
temper,  and  will  curse  and  swear  at  his  best  friends.  This 
sleep  does  not  rest  the  brain  at  all,  as  when  they  do  wake  up 
voluntarily  they  are  by  no  means  refreshed,  and  immediately 
have  recourse  to  another  stimulant,  which  generally  freshens 
them  up  for  a  short  time,  but  they  very  soon  require 
re-stimulating. 

In  the  early  days  of  their  career,  these  men  often  go 
through  a  large  amount  of  fatigue,  and  consequently  for  a 
time  ward  off  the  mental  effects  of  their  drinking.  They 
will  hunt  vigorously  and  slioot,  walking  long  distances,  but 
the  excitement  of  horse  exercise  is  what  they  most  delight 


36  DISEASES   OF    INEBRIETY. 

in,  as  the  fatigue  enables  them  to  drink  large  quantities  of 
stimulants  without  much  apparent  effect.  But  after  several 
years  the  muscular  as  well  as  mental  system  begins  to  fail. 
They  cannot  go  through  the  fatigue  they  were  formerly 
capable  of.  Their  will  also  fails.  Overnight  they  will  make 
engagements  and  promises  for  the  morrow,  but  the  morrow 
finds  them  unable  to  perform  their  promises,  nor  have  they 
the  will  to  carry  their  project  out. 

Every  now  and  then  the  patient  acknowledges  that  he 
is  drinking  himself  to  death,  and  he  will  slacken  in  and 
reduce  his  quantities  of  stimulants,  but  never  leave  off 
entirely.  He  very  soon,  however,  resumes  his  usual  large 
potations.  Occasionally  he  can  be  induced  to  go  to  a 
home  or  inebriate  asylum  for  a  time,  but  he  never  stays 
very  long,  and  is  no  sooner  out  than  he  resumes  his  former 
habits.  It  is  a  fearful  existence,  the  constant  craving  for 
fluid,  and  that  fluid  must  have  some  taste.  All  dipsoma- 
niacs have  a  complete  antipathy  to  water.  They  will  drink 
anything  but  water.  If  they  cannot  get  stimulants  they 
will  drink  soda-water,  lemonade,  or  ginger-beer,  in  enor- 
mous quantities,  so  much  so  indeed  that  the  mere  quantity 
of  these  apparently  harmless  fluids  which  they  drink  is 
quite  sufficient  in  itself  to  ruin  their  digestive  powers. 
Many  people  think  that  it  is  only  necessary  to  substitute 
these  supposed  harmless  fluids  for  alcoholic  drinks  to  pro- 
duce a  cure.  The  idea  is  entirely  fallacious,  as  large 
quantities  of  those  fluids  are  as  likely  as  not  to  induce 
dipsomania  itself.  There  are  two  classes  of  dipsomaniacs 
that  are  very  different  from  each  other  in  their  habits  of 
eating.  One  set  has  the  most  voracious  appetite,  eating 
enormous  quantities  of  meat,  cooked  in  all  forms.  These 
patients  are  generally  wine-drinkers,  and  very  often  claret- 
drinkers.  Another  set  of  patients  eat  very  little,  their 
stomachs  being  unable  to  retain  or  digest  the  food.  In  the 
first  class  the  large  quantities  of  food  taken  is  not  properly 
digested,  as   is   evidenced   by   their  constant  call  to  get  rid 


DIPSOMANIA  :     ITS   HISTORY   AND    RELATION.  37 

of  their  excrement.  In  fact  some  of  these  patients  seem  to 
occupy  a  great  part  of  their  time  by  evacuating  their 
bladders  and  rectums  of  the  large  quantities  of  food  and 
drink  they  ingest.  The  diet  of  those  who  only  eat  a  small 
quantity  is  generally  a  meat  one. 

Tlieir  usual  routine  of  life  consists  in  getting  up  early 
or  late  in  the  afternoon,  rarely  in  the  forenoon.  But  dur- 
ing the  morning  they  have  been  taking  continual  small 
doses  of  beer,  champagne,  hock,  or  claret,  generally  diluted 
with  soda  or  seltzer,  and  have  short  snatches  of  a  boozy 
sleep.  Having  come  out  by  the  afternoon  they  attempt  a 
dinner  in  the  evening,  and  with  a  fair  amount  of  liquor  in 
them,  they  bring  themselves  up  to  the  scratcli  to  play  bil- 
liards or  cards,  but  they  soon  get  tired,  as  tliey  call  it,  and 
lie  down  and  go  off  to  sleep.  By  about  one  or  two  in  the 
morning  they  wake  up,  and  from  then  till  eight  or  nine  is 
their  miserable  time.  They  cannot  sleep.  The  effect  of  the 
liquor  is  passing  off  and  they  get  frightfully  nervous. 
They  often  wander  about  the  house,  and  if  tliey  cannot 
obtain  any  liquor  before  the  general  hour  of  rising  of 
others,  they  are  usually  reduced  to  a  state  verging  on  deli- 
rium tremens.  Directly  they  get  some  liquor,  however,  they 
go  and  undress  and  go  to  bed,  and  so  on  till  the  afternoon, 
when  the  repetition  of  the  niglit  before  takes  place. 

In  the  early  history  of  dipsomaniacs  they  have  usually 
had  one  or  more  attacks  of  delirium  tremens,  but  after 
recovering  in  a  way  from  them  they  are  never  able  to  drink 
the  large  quantities  of  stimulants  they  used  to  do  formerly, 
as  they  get  so  mucli  sooner  prostrated  and  intoxicated  that 
they  never  get  real  delirium  tremens  again.  We  have  seen 
patients  in  whom  the  disease  is  of  long  standing  so  altered 
that  one  or  two  glasses  of  beer  would  make  them  quite 
boozy.  Also,  after  the  attacks  of  delirium  tremens,  they 
never  seem  to  recover  tlieir  muscular  tone  and  power,  and 
consequently  cannot  go  tlirough  the  same  amount  of  exer- 
cise.  The  reason  of  this  is  of  course  that  they  go  on  drinking. 


38  DISEASES    OF   INEBRIETY. 

If  tlieir  liquor  was  stopped,  pliysically  they  would  get  quite 
well.  A  characteristic  sign  of  the  clironic  dipsomaniac  is  a 
diffuse  roseate  hue  of  face  and  neck  and  a  watery  aspect  of 
eye.  They  are  generally  full-bodied,  but  they  are  always 
weak  on  their  legs,  and  late  in  the  disease  get  into  almost  a 
state  like  locomotor  ataxy.  Besides  the  roseate  hue  of  face 
there  is  another  symptom  indicating  the  determination  of 
blood  to  the  head,  and  that  is  a  constant  recurrence  of  slight 
hemorrhages  from  the  nose.  The  pocket-handkercliiefs  of 
dipsomaniacs  always  contain  secretion  mixed  with  blood. 
This  is  only  found  in  old  standing  cases,  and  is  often  alone 
due  to  the  congestion  of  the  liver,  which  is  constantly  pres- 
ent. The  urine  in  the  morning  is  generally  very  high  col- 
ored. The  pulse  in  the  morning  is  also  always  weak,  soft, 
and  small.  We  have  already  stated  our  belief  in  the  absence 
of  any  moral  feeling  in  these  patients.  It  is  hard  often  to 
decide  whether  the  drink  may  not  have  removed  their  moral 
sense  by  its  effects  on  the  brain.  For  a  man  may  have  pos- 
sibly started  in  life  with  a  fair  proportion  of  the  moral  sense, 
but  the  physical  action  of  alcohol  on  his  cerebrum  may  have 
destroyed  his  moral  appreciations.  No  doubt  this  occurs  in 
truly  acquired  dipsomania.  But  in  these  latter,  the  disease 
comes  on  later  in  life.  Where  the  disease  is  hereditary,  and 
is  an  insanity,  and  begins  earlier  in  life,  one  generally  finds 
that  even  in  their  boyhood  they  evidently  were  devoid  of 
moral  sensibility.  The  cunning  of  these  patients  in  using 
every  artifice  to  get  drink,  when  they  know  efforts  are  being 
made  to  keep  them  from  it,  is  really  wonderful.  They  will 
hide  bottles  of  spirits  among  their  clothes.  They  will,  in 
the  earlier  stage,  walk  long  distances  so  as  not  to  be  seen 
drinking,  will  use  persuasions  and  threats  to  those  attend- 
ing on  them,  and  will  eventually  beg  anybody  for  drink  to 
satisfy  their  craving. 

The  symptomology  of  inebriety  is  far  more  familiar  to 
the  reader  than  its  philosophy  and  causation,  hence  it  is 
omitted  for  want  of  room. 


CHAPTER  V. 

SOME  CONSIDERATIONS  OF  THE  PHILOSOPHY  AND  HIGHER 
RANGES  OF  CAUSES. 

Men  in  the  world  can  be  very  readily  graded,  as  they 
ascend  from  tlie  lowest  to  the  highest  types,  by  two  very 
essential  qualifications — the  one,  their  degree  of  intellectual 
sense ;  the  other,  their  degree  of  moral  sense. 

By  the  lowest  type  of  men  we  mean  one  both  ignorant 
and  immoral  ;  by  the  highest  type,  we  mean  one  both  intelli- 
gent and  moral  These  two  qualifications  can,  to  a  consid- 
erable extent,  be  separated  :  we  often  speak  of  the  7netttal 
and  w^ra/ qualities  as  distinct;  and  we  recognize  the  fact 
that  in  tlie  same  individual,  frequentl}',  the  levels  of  these 
two  qualities  do  not  correspond.  For  instance,  we  can  have 
one  person,  who  will  grade  higher  in  his  morality  than  in  his 
intelligence,  and  another,  lozver  in  his  morality  than  his  in- 
telligence. Tlie  rule,  however,  is, — the  ability  to  think  is 
accompanied  by  an  equal  ethical  ability. 

In  the  gradual  advance  of  a  race  from  savagery  to  civil- 
ization, their  progress  is  occasioned  by  and  marked  by  grad- 
ual improvement  in  both  these  particulars. 

In  any  man,  his  intelligence  and  his  ethical  ability  are 
raised  to  a  level  corresponding  with  his  previous  practice  in 
performing  these  kinds  of  action.  The  savage,  compared 
with  the  more  advanced  man,  is  inherently  less  able  to  per- 
form these  kinds  of  thouglit,  and  as  he  progresses  upwards 
towards  civilization,  through  generations,  there  is  a  gradual 
improvement  in  his  ability,  until  as  a  most  advanced  man  he 
finally  has  most  capacity  to  think  and  to  do  right. 

39 


40  DISEASES   OF   INEBRIETY. 

The  first  essential  in  an  advancing  man,  or  advancing 
race,  is  activity.  An  indolent,  idle  man  or  race  never  ad- 
vances. It  is  the  activity  or  exercise  of  the  brain  that  increases 
its  ability.  Accomplishments  and  excellences  are  acquired 
only  by  practice  and  exercise. 

The  rapid  competitions  of  active  society,  therefore,  ne- 
cessitate activity  on  the  part  of  the  individual  to  avoid  sup- 
pression and  elimination.  Hence,  improvement  of  individ- 
uals is  most  rapid  in  active  society.  The  continuous  brain- 
w^ork,  which  under  such  circumstances  becomes  a  necessity, 
improves  the  thinking  ability  of  the  rising  man. 

In  the  rising  man,  because  it  is  a  necessity,  his  intellect- 
ual (competive)  ability  antedates  to  some  extent  his  ethical 
sense.  In  a  society  which  is  advancing  from  a  savage  to  a 
civilized  grade,  competitive  ability  is  acquired  before  ^^w^xsX 
communal  interests  require  the  harmonizing  of  the  com- 
petitions. The  safety  and  the  welfare  of  society  soon 
demand  that  the  competitions  of  its  membership  shall  be 
harmonized.  This  gives  rise  gradually  to  the  evolution  of 
higher  and  higher  rules  of  conduct.  Public  opinion  and 
moral  sense,  with  laws  and  government  to  enforce  them, 
thus  become  of  a  higher  and  higher  grade,  until  the  highest 
type  is  reached. 

In  this  gradual  improvement  of  society,  the  advancing 
man  is  more  and  more  practiced  in  ethical  observances, 
until,  as  an  accompaniment  to  his  improving  ability  to  com- 
pete, there  also  grows  in  him  a  better  ethical  sense  of  the 
rights  of  others.  A  high  ethical  sense  may  well  be  called 
the  capsto7ie  of  human  improvement. 

In  the  best  communities  to-day  we  find  some  individuals 
— in  most  communities  they  are  few,  in  no  community  do 
they  reach  a  majority — who  have  a  high  order  of  ethical 
sense  inherent  in  them.  These  persons  are  always  inherently 
intelligent,  for  it  takes  the  highest  order  of  intelligence  to 
so  understand  the  complexities  of  civilized  competitions 
as  to  be  able  to  formulate   and  maintain  high  rules  of  con- 


PHILOSOPHY   AND   HIGHER   RANGES    OF   CAUSES.  41 

duct  to  suit  them.  Such  a  high  order  of  man — highly  intel- 
ligent and  highly  ethical — is  only  the  result  of  a  long  line 
of  generations  of  this  kind  of  practice. 

We  spake  of  civilized  countries,  and  of  civilized  societies 
as  though  their  membership  were  uniform.  This  is  not  so. 
Every  community,  even  that  graded  highest,  will  furnish 
examples  ranging  all  the  way  down  from  the  highest  type, 
just  described,  to  the  lowest.  In  any  community,  in  a  so- 
called  civilized  country,  we  can  find  persons  who  inherently 
grade  very  low  in  thinking  ability  and  in  ethical  sense. 
They  are  at  the  savage  level.  A  great  many  have  the  sav- 
age level  of  moral  sense,  while  they  hold  a  higher  level  in 
intellectual  sense.  This,  in  my  opinion,  is  particularly  the 
case  with  deteriorating  or  degenerating  individuals,  they 
have  lost  their  ethical  sense  in  advance  of  their  intellectual, 
— the  latest  evolved  and  most  delicate  goes  off  first. 

We  have  not  yet  invented  a  cerebral  dynamometer,  by 
which  we  can  test  and  record  a  man's  intellectual  capacity 
or  his  moral  strength,  but  in  our  associations  with  others 
we  instinctively  recognize  such  information  to  be  very 
valuable.  It  is  interesting  to  note  how  much  we  are 
engaged  in  this  very  kind  of  work.  We  are  continually 
making  estimates  of  this  character,  and  it  is  astonishing,  in 
a  crude  way,  how  expert  we  become  at  it. 

In  making  our  estimates  in  society,  the  position  a  per- 
son holds  is  one  to  which  he  has  arisen  from  a  lower  level 
or  one  to  whicli  he  has  lapsed  from  a  higher  one.  Human 
brain  ability  is  not  by  any  means  a  constant  quality — there 
is  no  standstill  level.  The  index  rises  and  falls  in  the 
course  of  the  life  of  the  person,  and  also  it  varies  in  the 
course  of  the  line  of  descent.  In  so-called  civilized  society 
the  lapses  probably  constitute  the  large  majority  of  the 
incompetent. 

Ability,  at  whatever  height  it  occurs  in  an  advancing 
man,  is  raised  to  tliat  level  solely  by  previous  brain  practice. 
The  practice  is  either  personal  or  ancestral.     The  person 


42  DISEASES   OP   INEBRIETY. 

receives  his  ability  at  a  certain  level  from  his  ancestry  and 
raises  it  or  lowers  it  by  his  habits  of  thouglit.  By  far  the 
best  and  most  stable  ability  is  that  which  is  the  result  of 
practice  reaching  through  a  long  ancestral  line. 

While  it  is  true  there  is  only  one  way  of  improving  brain 
ability,  namely,  by  activity,  there  are  several  ways  of  lower- 
ing it.  There  are  several  ways  in  which  the  /tz/x^^  members 
of  society  have  reached  their  levels. 

Brain  inactivity,  I  have  already  stated,  is  ihe^ physiological 
method  of  lapsing.  There  are  a  number  of  pathological 
methods. 

Our  pathology  is  always  injured  or  impaired  physiology, 
so  I  have  dwelt  this  long  upon  the  physiology  of  cerebration, 
in  order  more  properly  to  approach  its  pathology. 

Whatever  injures  the  structure  of  the  brain  impairs  its 
functional  action.  Tliis  impairment  is  exhibited  in  altered 
conduct,  in  a  loss  of  ability,  both  intellectual  and  ethical. 

We  can  go  tiirough  the  wards  of  our  insane  asylums 
and  find  numbers  of  men,  who  once  ranked  higii  in  intelli- 
gence and  in  morals,  now  lowered  in  both.  Defect,  injury, 
or  disease  now  renders  the  brain  of  each  of  them  less  able 
to  perform  at  as  high  a  level  as  it  formerly  did. 

Insanity,  indeed,  is  only  a  name  we  give  to  a  certain 
degree  of  brain  incapacity.  As  generally  defined,  it  simply 
means  there  is  such  a  degree  of  incapacity  as  renders  the 
person  an  tinjit  member  of  society.  For  this  reason,  for  his 
own  or  his  neighbor's  safety,  he  has  to  be  placed  under  for- 
cible restraint  ;  his  brain  is  so  lowered  in  intellectual  ability 
that  he  is  unable  to  compete  for  his  living,  so  a  support  has 
to  be  given  him  ;  and  it  is  so  lowered  in  ethical  ability  that 
he  is  a  nuisance  or  a  danger  to  others,  so  he  has  to  be 
restrained. 

In  society,  short  of  the  degree  called  insane,  we  have 
innumerable  varieties  and  kinds  of  disability,  exhibited  by 
the  peculiar,  the  cranky,  and  the  delirious. 

Besides    the    long  list    of    diseases,    traumatisms,    and 


PHILOSOPHY   AND   HIGHER   RANGES   OF   CAUSES.  43 

defects  of  the  brain,  which  impair  its  functional  capacity, 
we  also  have  a  long  list  of  drugs,  wiiicli,  taken  into  tlie  circu- 
lation, bring  down  tlie  brain's  capacity  to  a  lower  level. 

I  need  not  go  over  the  long  list,  nor  point  out  the  pecu- 
liarities of  their  actions,  but  at  once  mention  alcohol  ns  one 
of  them.  This  agent,  from  its  general  use,  brings  down 
more  brain  capacity  in  the  world — and  it  certainly  does  a 
great  deal  to  produce  the  lapsed  me?nbers  of  civilized  society. 

If  it  were  not  for  the  fact  that  alcohol  has  in  the  system 
a  special  effect  upon  nerve  centers,  particularly  high  brain 
structure,  men  would  never  have  used  it  as  a  beverage.  In 
seeking  and  taking  it  the  alcohol  drinker  is  after  its  brain 
effect. 

The  brain  is  the  organ  of  thought  and  all  conscious  ac- 
tion. The  partially  hardened  condition  of  its  delicate  struc- 
ture that  alcoiiol  produces,  renders  it  less  capable  of  cellular 
motion  or  action.  Its  conscious  sensitiveness  is  lessened 
thereby.  It  is  less  able  to  feel.  The  alcoholized  man  there- 
fore says  he  "  feels  better"  or  "  feels  good,"  and  acknowl- 
edges that  this  kind  of  lowered  sensitiveness  is  what  he 
likes.  He  "  feels  better"  if  his  brain  feels  less  any  discom- 
fort or  pain  he  may  have.  Even  in  health,  if  he  have  no 
special  discomfort,  the  benumbed  condition  is  a  more  com- 
fortable one.  The  well  man  therefore  says  he  "  feels  good.** 
Tiie  luxury  of  alcohol  drinking  consists  in  this  condition  of 
the  brain. 

I  wish  to  draw  attention  to  the  fact,  that  in  order  to 
obtain  the  pleasant,  comfortable  condition  of  lowered  sensi- 
tiveness, the  alcohol  drinker  does  not  avoid  or  fail  to 
have.the  alcohol  effects  on  his  brain — there  is  a  general 
lowering  of  function.  When  the  brain's  ability  to  feel  is 
lowered,  its  ability  to  think  and  to  adjust  conduct  ethically 
are  also  lowered.  The  keenness  of  a  high  ethical  sense  is 
probably  ihG  first  thing  blunted. 

The  disability  of  the  alcohol  drinker  will  vary  accord- 
ing to  the  amount  taken;  according  to  the  inherent  strengt/i 


44  DISEASES   OE  INEBRIETY. 

of  brain  structure  ;    and  according  to  the  length  of  time  the 
brain-abuse  is  continued. 

For  instance,  first,  according  to  the  amoutit  taken,  con- 
scious sensitiveness  lets  down  from  a  slightly  benumbed, 
comfortable  condition,  to  that  of  complete  anaesthesia  ; 
intellectual  ability  varies  from  being  "  a  little  off "  to  the 
condition  of  a  temporary  dement  ;  the  ethical  sense  varies 
from  slight  indecorum  to  full  viciousness  or  madness. 
Secondly,  the  degree  of  brain  disability  under  alcohol  will 
vary  according  to  the  inherent  brain  strength  of  the  drinker. 
Weak  brains  will  be  lowered  in  ability  more  than  strong 
ones,  and  low  grade  savage  brains,  or  defective  ones,  will 
exhibit  their  incapacities  in  the  lines  of  their  deficiencies. 
Thirdly,  the  disability  will  also  vary  in  proportion  to  the 
/(?«^/// t*/ //;;;^  the  drain-drug  abuse  is  continued.  A  single 
debauch  can  be  fully  recovered  from,  but  long-continued 
use  produces  such  an  injury  the  full  function  is  never 
restored. 

Sometimes  all  three  of  these  conditions  obtain  in  the 
same  person  ;  when  this  is  the  case,  the  degeneracy  of  brain 
function  is  extreme.  The  inebriates  constitute  this  extreme 
class,  always  degenerated  to  a  very  low  level  in  intellectual 
sense  and  ethical  sense.  Of  course  there  is  a  tendency  to 
return  to  previous  capacity  when  the  brain-drug  abuse  is 
left  off^,  but  I  question  whether  an  inebriate's  brain  is  ever 
fully  restored  to  its  previous  capacity,  or  ever  reaches  the 
level  it  would  have  occupied  without  the  injury. 

As  society  advances  from  a  savage  to  a  civilized  level 
success  depends  more  and  more  on  brain  strength.  The 
most  advanced  society  pays  the  highest  premium  for  brain 
ability.  In  active  civilized  society,  the  safety  and  success 
of  the  individual  depend  almost  altogether  upon  this  qualifi- 
cation. In  savage  society,  the  muscle  strength  suppresses 
the  weak,  in  advanced  society  it  is  the  brain  strength  of 
the  more  competent  that  suppresses  the  incompetent. 

The  drinkine  man   lets  down  in  business  and  loses  his 


PHILOSOPHY  AND   HIGHER   RANGES  OF  CAUSES.  45 

money  because  his  thinking  capacity  is  lowered  by  his  habit 
— his  ability  is  weakened.  The  drinking  man  also  lets  down 
in  mor-dls, /al/s  into  vicious  habits,  because  liis  ethical  sense 
is  weakened. 

In  modern  society,  brain  idleness  probably  puts  most 
men  into  the  eliminating  level  ;  next  to  idleness  comes  alco- 
hol. These  two  agencies  rapidly  rid  crowded  society  of 
their  unfit  membership.  Nothing  is  so  rapid  an  elimi?iator 
as  alcohol.  The  least  fit,  both  in  the  idle  wealthy  ranks, 
and  in  the  idle  poor  ranks,  are  most  given  to  its  use. 
Under  the  light  of  advancing  science,  the  use  of  alcohol  is 
becoming  more  and  more  confined  to  the  class  of  the  weak- 
brained  and  the  vicious.  The  intelligent,  for  the  sake  of 
maintaining  this  intelligence  and  superior  fitness,  are 
learning  to  leave  it  off. 

Society  is  much  interested  in  the  intellectual  level  of  its 
members,  but  it  is  most  interested  in  tiieir  ethical  level. 
The  safety  and  survival  of  tlie  individual  are  most  depen- 
dent upon  his  intellectual  ability  ;  society,  though,  is  prin- 
cipally interested  in  his  ethical  ability.  The  safety  and 
welfare  of  society  depend  upon  the  moral  status  of  its 
people.     The  good  of  society  demands  this. 

Communities,  races  and  nations,  like  individuals,  are 
engaged  in  competitive  life.  The  most  successful  is  the 
one  which  has  the  high  intellectual,  progressive  capacities 
of  its  people  welded  into  a  harmonious,  united  whole  by  a 
high  ethical  sense. 

There  is  a  very  satisfactory  scientific  explanation  there- 
fore to  the  fact,  that  the  most  altruistic  persons,  those  most 
interested  in  public  good,  have  always  been  opposed  to 
alcohol  drinking.  They  recognized  the  fact  that  it  lowered 
the  intellectual  and  moral  abilities  of  the  people  and 
tended  to  weaken  and  disintegrate  society.  Probably  one 
reason  they  have  never  succeeded  better  in  enforcing  their 
opinions  upon  the  attention  of  the  alcohol  users,  is  because 
they  have  not  had  the  advantage  of  recent  scientific  knowl- 


46  DISEASES    OF   INEBRIETY. 

edge  to  back  their  instructions — the  brain  has  been  left  out 
of  their  philosophy  altogetiier. 

I  have  often  been  make  impatient  in  listening  to  the  lec- 
turer presenting  the  "  scientific  aspects  of  tlie  alcohol  ques- 
tion" to  an  audience,  to  see  him  illustrate  extensively  with 
charts  and  spend  hours  to  show  the  effects  of  alcohol  upon 
the  coats  of  the  stomach,  and  upon  the  structure  of  the 
liver,  the  lungs,  and  the  kidneys,  and  never  allude  once  to 
the  brain,  when  the  fact  is,  alcohol's  principal  effect  is  upon 
this  organ  ;  and  the  functions  of  this  organ  so  far  transcend 
the  functions  of  all  the  others,  that,  I  might  say,  there  is  no 
comparison. 

When  the  individual  in  society  is  taught  the  fact,  which 
he  seldom  knows,  that  alcohol  incapacitates  this  very  organ 
upon  which  his  safety  and  success  in  the  competitive  world 
depend,  he  will  be  very  much  less  inclined  to  use  it.  And 
when  society  recognizes  that  with  alcohol  a  low-grade,  vic- 
ious man  can  be  made  chemically  out  of  its  excellent 
man,  and  that  tliis  process  is  continually  going  on  among 
all  its  ranks,  it  will  be  more  alive  to  spread  scientific 
instruction  upon  the  subject. 


CHAPTER  VI. 

INEBRIATE      DIATHESIS       AND       ITS      CONDITIONS      AND 

RELATIONS. 

By  the  inebriate  diathesis  is  meant  that  constitutional  pro- 
clivit}^  or  neurosis,  which  impels  to  the  inordinate  use  of 
narcotics. 

This  includes  the  hurtful  consumption  of  opium,  chloral, 
cocaine,  etc.,  as  well  as  of  alcohol.  The  latter,  however, 
will  be  more  particularly  the  subject  of  the  present  inquiry. 

The  peculiar  bent  of  the  constitution  herein  referred  to 
has  been  classed  as  a  specific  mania  ;  and  has  been  called 
by  Dr.  Norman  Kerr  and  otliers  tiarcomania. 

In  the  interest  of  brevity,  I  will  begin  what  I  wish  to 
advance  on  this  subject  with  a  homely  illustration.  We  are 
assured  by  anatomists  that  the  bones  of  the  skeleton — it 
matters  not  what  shapes  they  assume — are,  as  to  form, 
modifications  of  a  single  fixed  type.  This  type  is  repre- 
sented by  the  separate  and  distinct  bones  of  the  spinal 
column. 

When  we  attentively  consider  the  group  of  nervous 
maladies  known  as  the  neuroses,  we  perceive  that  they  bear 
a  close  relationsliip  with  one  another.  We  learn  that 
either  member  of  this  family  may  assume  the  character- 
istics and  features  of  some  other  member.  We  become 
aware  of  the  fact  that,  seemingly,  one  of  them  may  be 
transformed  into  the  semblance  of  some  kindred  neurosis. 
We  see  that  this  transmutation  may  be  effected  through  the 
operation  of  heredity — a  neurotic  form  in  ancestry  appear- 
ing as  a  different  form  in  posterity.     We  are  also  impressed 

47 


48  DISEASES    OF    INEBRIETY. 

that  this  interchange  may  even  take  place  in  the  same  per- 
son ;  as  when  epilepsy,  or  dipsomania,  gives  way  to 
amnesia,  or  some  other  neurosis. 

While  it  is  reasonable  and  necessary  to  study  the  bones 
of  the  skeleton  separately  and  individually,  in  order  to 
arrive  at  right  conclusions  respecting  the  body  as  a  whole, 
it  is  also  philosophical,  and,  indeed,  essential  to  a  correct 
apprehension  of  the  subject,  to  study  with  care  the  distinct 
type  of  which  these  bones  may  be  modifications.  It  is 
desirable  to  examine  the  spinal  bones,  so  that  a  proper 
estimate  may  be  made  of  the  nature  of  the  modifications 
assumed  by  various  parts  of  the  skeleton — and  the  reasons 
of  them. 

The  true  and  perfect  type  of  which  the  entire  assemblage 
of  neurotic  maladies  is  representative,  is,  it  appears  to  me, 
simply  epilepsy.  The  varying  aspects  which  this  disease 
assumes,  its  several  grades  of  intensity,  as  well  as  its  origin, 
— so  far  as  that  is  known — seem  to  point  it  out  as  the  great 
central  source  of  the  several  neurotic  besetments.  If  this 
be  true,  even  in  a  general  sense,  it  follows  that  in  seeking  the 
origin  of  the  inebriate  diathesis  an  examination  of  the  causes 
and  phenomena  of  epilepsy  will  be  a  necessar}'  work. 

Epilepsy  has  been  classified  as  either  centric  or  excentric. 
That  is  to  say,  it  arises  sometimes  from  causes  situated 
within  the  brain  ;  and  at  other  times,  from  causes  exterior 
to  the  brain,  but  influencing  tlie  condition  of  that  organ. 
These  causes,  while  often  attended  by  pain,  may  operate 
without  exciting  actual  pain.  In  epilepsy  there  is  a  con- 
stant, unrelenting  irritation,  nagging  the  great  nervous 
center.  This  irritation  may  be  simply  a  morbid  impres- 
sion acting  through  organic  sensibility,  or  it  may  be 
attended  by  actual  pain  and  distress. 

Hence  teething,  indigestion,  and  worms  excite  convul- 
sions in  children,  which  are  epileptoid.  So,  too,  tape- 
worms, affections  of  the  liver,  or  stomach,  or  kidneys  and 
the    like,    may    excite    true   epilepsy    in    the    adult.     It  is 


INEBRIATE    DIATHESIS    AND    ITS    CONDITIONS.  49 

obvious  that  epilepsy  from  such  causes  is  more  or  less 
amenable  to  treatment.  But  the  treatment  of  centric  epi- 
lepsy— frequently  hereditary,  with  its  proximate  cause  within 
the  brain — is  more  difificult  ;  and  usually  the  most  that  can 
be  expected  is  a  certain  toning  up  of  the  general  constitu- 
tion, by  which  means  the  effects  of  the  original  evil  may  be 
better  endured.  Through  such  measures  some  hope  may  be 
entertained,  perhaps,  that  the  violence  of  the  epileptic 
seizure  may  be  abated.  In  short,  some  slight  possibility 
may  appear,  that,  instead  of  true  and  complete  epilepsy, 
there  may  be  substituted  amnesia,  or  neuralgia,  or  some 
other  and  milder  one  of  the  neurotic  forms. 

An  educated  and  refined  gentleman — now  a  retired 
clergyman — once  suffered  with  repeated  and  severe  attacks 
of  epilepsy.  The  coma  continued  many  hours.  The  epilep- 
tic form  disappeared  under  treatment  ;  but  it  was  followed 
by  seasons  of  absent-mindedness  (amnesia),  lasting  for 
days.  No  recollection  of  the  life  of  this  neurotic  trance 
was  or  is  retained.  The  same  individual  suffered  after- 
wards for  nearly  two  years  with  excruciating  pains.  They 
were  referred  at  first  to  the  stomach,  cancer  being  feared. 
Subsequently  they  were  located  in  the  pleura.  Finally  the 
trouble  was  attributed  to  biliary  calculi.  The  "cure"  was 
complete,  sudden,  and  unexpected.  No  calculi  ever  put  in 
an  appearance.  Tlie  physician  in  attendance  upon  the  case 
in  its  neuralgic  form  had  no  accurate  knowledge  of  the 
previous  history  of  his  patient. 

Central  or  centric  epilepsy  is  often  hereditary.  But  that 
fact  does  not  militate  against  the  idea  that  irritation  is  the 
primum.  mobile  of  the  disease.  The  misshapen  head,  the 
undeveloped  brain,  may  readily  be  supposed  to  act  as 
sources  of  unceasing  irritation.  Injuries  to  the  head  pro- 
ducing epilepsy  are  too  common  to  call  for  remark.  Know- 
ing, then,  that  irritation  is  an  efficient  cause  of  epilepsy  in 
all  cases  where  its  cause  has  been  satisfactorily  determined, 
we  are  justified  in  assuming  that  in  those  cases  where  the 


50  DISEASES    OF   INEBKIETY. 

source  of  the  malady  does  not  plainly  appear,  the  high 
probabilities  are  that  some  undiscovered  or  masked  point 
of  irritation  is  nevertheless  operative  as  the  proximate 
cause  of  the  disease. 

I  sa.y  proximate  cause — for  it  is  evident  from  the  fact  that 
irritation  does  not  always  produce  epilepsy,  that,  after  all, 
there  must  be  some  peculiar  predisposing  constitutional 
susceptibility  in  epileptics  that  is  not  found  in  people  gen- 
erally. And  here  is  the  key  which  unlocks  at  least  some 
of  the  secrets  of  heredity.  It  is  the  peculiar  impressibility 
of  the  epileptic  constitution,  which,  being  hereditary, 
makes  possible  the  heredity  of  the  disease  itself — circum- 
stances favoring  its  full  development  being  presented.  It 
also  makes  possible  the  heredity  of  those  neurotic  forms 
recognized  as  kindred  with  epilepsy.  This  constitutional 
susceptibility  therefore  explains  the  heredity  of  inebriety, 
hysteria,  chorea — epilepsy  itself.  It  explains  the  heredity 
of  dipsomania,  and  all  the  features  of  the  inebriate 
diathesis. 

When  there  is  present  a  peculiar  constitutional  tendency 
allied  to  the  epileptic  diathesis,  then  any  irritation  of 
nerve — if  severe  and  unremitting — will  be  likely  to  develop 
some  form  of  neurotic  disease  ;  and  this  will  correspond, 
not  with  the  nature  of  the  irritation  itself,  but  with  the 
nature  of  the  constitutional  trend.  Dr.  Cheyne  refers  to  a 
case  of  epilepsy  "  which  was  caused  by  a  cartilaginous 
tumor  of  the  size  of  a  large  pea,  which  was  situated  on  a 
nerve.  Upon  excision  of  the  tumor  the  fits  ceased."  Why 
may  not  inebriety — narcomania — be  developed  by  causes  as 
small  and  apparently  as  trivial  ? 

We  are  admonished  to  look  for  the  pathological  condi- 
tion provocative  of  inebriety.  Wliy  not  insist  upon  some 
invariable  pathological  condition  in  explanation  of  epi- 
lepsy ?  Very  often,  indeed,  this  morbific  cause  cannot  be 
determined  ;  but  when  it  does  appear,  it  is  always  found 
to   consist   of   some    point,    or   points,    of    unflagging  and 


INEBRIATE   DIATHESIS   AND    ITS    CONDITIONS.  51 

remorseless  irritation.  It  may  be  repletion,  or  it  may  be 
famine  and  weakness.  It  may  be  too  much  blood,  or  too 
little  blood.  It  may  be  observed  in  the  center  of  the  cir- 
culation— the  heart — or  it  may  reveal  itself  in  irregularities 
and  disturbances  of  the  equilibrium  among  the  arteries, 
veins,  and  capillaries.  But  virhatever  else  it  is,  or  wherever 
located,  it  is  irritation  worrying  and  exhausting  the  nervous 
powers. 

Now  certain  constitutions  bear  up  through  the  changes 
of  life  fairly  well,  until  some  serious  injury  overtakes  the 
physical  organization,  such,  for  example,  as  a  blow  upon 
the  head,  a  wound  in  battle,  or  even  a  long  and  trying  ill- 
ness. Irritation  at  once  begins  to  do  its  work.  The  ordi- 
nary and  natural  constitution  gives  way.  It  is  weak, 
exhausted,  weary.  It  has  become  unequal  to  the  require- 
ments even  of  ordinary  life.  It  reaches  out  for  aid,  or  rather 
for  rest  and  repose.  Tlie  inebriate  diathesis  is  established, 
and  the  anaesthetic — the  lethal  influence  of  narcotics,  and 
especially  of  alcohol — is  invoked.  The  call  is  not  feeble 
and  uncertain,  but  earnest  and  reckless. 

An  habitual  drunkard  "shot  a  bar-keeper  and  set  fire  to 
a  saloon,  without  the  occurrence  of  any  quarrel  or  dispute. 
A  homicide  was  hung.  A  post-mortem  revealed  a  splinter 
of  bone  that  had  pressed  upon  the  brain  for  ten  years,  the 
result  of  a  blow  upon  the  head."  The  drinkinghabit  began 
shortly  after  tlie  infliction  of  the  injury, 

A  daily  paper  of  Cleveland,  Ohio,  dated  October  13, 
1886,  contains  a  pitiless  notice  of  the  downfall  of  the  Rev. 

,  a  clergyman  living  in  the  city,     "  In  the  gutter  again," 

was  part  of  the  heading.  The  account  says  the  reverend 
gentleman  was  sent  to  the  workhouse,  and  also  contains  a 
notice  of  the  dismissal  of  the  deliquent  from  his  position  in 
the  church,  with  a  warning  to  the  Christian  public  to  beware 
of  him.  On  the  6th  of  October,  1891,  after  the  lapse  of 
about  five  years,  the  same  daily  journal  contains  a  sympa- 
thetic account  of  a. post-mortem  held   upon  the  body  of  the 


52  DISEASES   OF   INEBRIETY. 

reverend  gentleman.  This  was  had  in  an  insane  hospital  in 
which  the  unliappy  man  had  been  placed.  T\\\% post-mortem 
disclosed  the  fact  that  the  man  was  carrying  in  his  lungs  a 
bullet  weighing  over  one  ounce,  received  w!ii!e  bravely 
fighting  the  battles  of  his  country  in  the  war  of  the  rebellion. 

It  is  evident  that  the  treatment  proper  for  inebriety  must 
occupy  a  very  wide  field,  as  its  proximate  causes  are  so 
varied.  It  is  filled  with  innumerable  facts,  requiring  the 
utmost  skill,  both  in  observation  and  discrimination.  In  its 
very  simplest  view,  three  considerations  must  be  kept  before 
the  mind  : 

ist.     The  causes  of  inebriety. 

2d.      The  nature  of  the  drunken  state. 

3d.  The  functional  disturbances  and  physical  degenera- 
tions that  are  sure  to  follow  long-continued  habits  of 
intemperance. 

The  Diathesis  and  Cachexia  of  this  affection  has  never 
been  carefully  studied,  but,  standing  on  the  border,  we 
catch  intimations  of  its  vast  possibilities,  awaiting  the 
future  investigator. 

A  diathesis  implies  a  special  predisposition  to  certain 
kinds  of  diseased  action.  A.  cachexia  is  a  developed  dia- 
thesis, a  real  condition  of  disease  of  the  blood  and  tissue. 
A  diathesis  is  a  more  or  less  remote  cause,  but  a  cachexia 
is  a  present  part  of  disease,  an  influence  on  the  organism. 
Using  these  terms  together,  certain  well  defined  conditions 
appear  to  be  traced,  from  which  inebriety  can  be  studied 
and  prognosed  witii  much  certainty.  The  first  and  most 
common  form  seen  may  be  classified  as  the  nervous  diathe- 
sis and  cachexia.  They  may  be  noted  by  their  spare 
bodies,  light  hair,  changeable  countenances  and  restless 
animation.  Easily  agitated,  intense  functional  activity,  so 
sensitive  as  to  show  signs  of  mental  disorder  when  excited. 
Mentally  their  views  of  life  are  unreal,  visionary  and 
exceedingly  changeable  ;  seldom  calm  and  deliberate,  but 
abrupt,  jerking,  and   when    exhausted,    prostrate.      When 


INEBRIATE   DIATHESIS   AND   ITS   CONDITIONS.  53 

this  is  inherited  it  is  often  accompanied  by  a  vain,  weak 
mind,  witli  boundless  self-esteem,  always  on  the  verge  of 
eccentricity. 

The  mind  dashes  from  one  extreme  of  emotion  to  an- 
other, either  showing  excitement  that  is  morbid,  or  degrees 
of  feebleness  that  are  abject.  Women  are  often  of  this 
class,  and  persons  from  the  wealtliier  circles  of  social  life. 
Luxurious  habits,  indulgence  of  wliims  and  fancies  in 
childhood,  are  active  causes  of  such  a  diathesis.  This  is  a 
distinct  type  of  mental  defect  from  which  inebriety  and 
insanity  are  an  almost  constant  sequence.  An  early  diag- 
nosis and  prognosis,  with  treatment,  would  furnish  the 
only  practical  means  of  escape  from  this  diathesis.  An- 
other condition  may  be  noted,  called  Strumous  Diathesis 
and  Cachexia.  Here  the  patient  has  diminished  vital  en- 
ergy, imperfect  nutrition,  with  mental  weakness  and  perver- 
sions, unnatural  special  developments,  which  have  a  con- 
stant tendency  to  exhaust  themselves,  as,  for  instance,  in 
case  of  extraordinary  mental  or  physical  genius,  where  the 
body  is  out  of  all  proportion.  Many  of  the  so-called  great 
men  of  the  world  belong  to  this  class.  They  are  nearly 
always  anaemic,  complain  of  frequent  headaches  and  have 
often  a  tuberculous  history,  accompanied  by  a  species  of 
degeneration  which  has  a  constant  tendency  to  concentrate 
in  some  particular  organ.  Any  exposure  to  cold  takes  on 
an  aggravated  type  of  symptoms,  or  injury  to  any  organ 
assumes  the  most  alarming  phase. 

The  nerve  centres  are  always  more  or  less  involved,  and 
siiocks  or  injuries  are  acutely  felt.  Inebriety  appears  as  a 
part  of  the  natural  history  of  this  diathesis.  Paroxysmal 
drunkards  belong  to  this  class,  and  of  all  others  they  are 
the  most  thoroughly  demented  during  the  attack.  In 
many  cases  an  Arthritic  Diathesis  and  Cachexia  are 
well  marked.  Here  a  chronic  state  of  imperfect  nutri- 
tion, with  mental  exaltation,  or  depression  existed.  In 
many  cases  a  history  of   rheumatism   and  deposits    about 


54  DISEASES    OF   INEBRIETY. 

the  heart,  with  calculi  of  gall  duct  and  bladder  were 
given.  The  circulation  was  weak,  and  the  intellect  un- 
stead\\  A  capricious,  irregular  appetite  accompanying 
these  conditions  often  forecasts  inebriety,  and  generally 
precedes  violent  attacks.     A 

Syphilitic  Diathesis  and  Cachexia 

are  known  by  temporary  headaches,  amaurosis  and  flying 
pains,  with  mental  and  moral  defects  of  various  grades  ; 
anaemia  and  affections  of  the  heart  are  often  present.  This, 
with  a  clear  syphilitic  history,  are  evidences  beyond  ques- 
tion. In  this,  diathesis  inebriety  or  insanity  develops  from 
the  least  exciting  causes.  There  is  a  He77iorrhagic  Diathesis 
and  Cachexia^  which  is  characterized  by  anaemia,  blood 
deficient  in  fibrin,  suffering  from  persistent  neuralgias,  and 
a  constant  tendency  to  copious  hemorrhage  from  the  slight- 
est causes.  Inebriety  often  follows  from  this  condition. 
Two  cases  have  fallen  under  my  notice  where  this  diathesis 
ended  in  uncontrollable  drunkenness  and  death,  A  Fibri- 
nous Diathesis  and  cachexia  may  be  the  active  cause  of  ine- 
briety by  the  constant  tendency  of  the  blood  to  exudations 
of  unhealthy  plasma,  and  general  hypertrophy  and  indura- 
tion of  the  cerebral  system,  all  the  functions  being  lan- 
guidly performed.  In  all  these  cases  the  normal  equili- 
brium of  the  nutritive  functions  is  destroyed,  and  inebriety 
follows  as  the  first  stage  of  degeneration.  These  are  some 
of  the  many  conditions  of  the  body  coming  down  from  in- 
heritance, well  marked,  and  so  often  preceding  this  affec- 
tion, as  to  be  called  active  and  predisposing  causes.  These 
conditions  are  not  always  distinct,  but  blend  into  each 
other,  multiplying  and  diverging. 


CHAPTER  Vir. 

GENERAL    PREDISPOSING    CAUSES. 

A  Study  and  grouping  of  the  general  causes  will  afford 
data,  from  which  we  can  understand  inebriety  in  its  first 
manifestations.  The  first  group,  called  General  Causes, 
are  those  which  frequently  produce  inebriety  in  common 
with  other  insanities.  Of  these  vicchanical  injuries  seem 
prominent,  such  as  injuries  or  concussion  of  the  brain  and 
spinal  cord,  and  consequent  alterations  of  nutrition.  Blows 
on  the  head  are  not  uiifrequently  followed  by  violent 
paroxysmal  drunkenness  ;  railroad  accidents,  where  the 
concussion  and  surprise  are  sudden  and  overwhelming, 
causing  intense  re-action  on  the  nervous  system  (produc- 
ing at  first  insignificant  physical  lesions),  often  develop 
inebriety  and  mania,  A  chaplain  in  the  late  war,  injured 
in  the  leg  by  a  shell,  although  but  a  simple  flesh 
wound,  was  several  months  in  the  hospital  before  recovery. 
From  this  time  he  became  an  incontrollable  drunkard,  and 
eventually  died.  A  prominent  physician  was  precipitated 
from  his  carriage  on  the  head,  and  received  flesh  wounds 
of  a  minor  character.  Very  soon  after  inebriety  was  devel- 
oped, and  he  ended  his  life  a  raving  maniac  in  an  asylum. 
The  rule  in  many  cases  indicates  that  injuries  of  the  brain, 
spinal  cord,  or  any  part  involving  numerous  nerve  trunks 
may  end  in  cerebral  disturbance,  of  which  drunkenness  is  a 
very  common  stage  of  the  lesic^n,  the  injury  being  small 
in  comparison  to  the  mental  disturbance  which  follows. 
Peripheral  irritation  or  reflex  excitability  has  been  noticed 
as   a  common  cause    in  many     cases.     In  a    letter  to    the 

55 


56  DISEASES    OF   INEBKIETT. 

Psychological  Joicrnal,  a  physician  describes  two  cases 
where  tape-worms  excited  inebriety  and  mental  liallucina- 
tions,  which  disappeared  on  tlieir  expulsion.  Several 
instances  are  on  recoid  where  the  use  of  pessaries  in  pro- 
lapsus uteri  and  the  prolapsus  alone,  has  been  the  cause 
of  mental  disturbances  of  which  drunkenness  was  the  most 
prominent  symptom.  The  irritation  from  prolonged 
lactation,  or  in  dysmenorrhaea,  ammenorrhea,  nymphomania 
and  functional  disturbances  of  the  genital  organs,  are 
frequently  the  beginnings,  and  in  many  cases  the  active 
causes  of  this  disease. 

A  case  of  chronic  masturbation,  which  ran  into  inebriety, 
came  under  my  notice  lately.  Numerous  cases  of  puer- 
peral insanity,  preceded  or  followed  by  inebriety,  are 
recorded  in  the  English  obstetrical  journals.  Cases  of 
drunkenness  during  pregnancy,  ending  at  delivery,  are  not 
uncommon.  A  remarkable  case  was  noted  at  the  Dublin 
Lying-in  Hospital,  some  years  ago,  of  a  woman,  who  during 
the  period  of  lactation,  drank  gin  to  excess.  This  craving 
for  stimulus  began  when  the  child  was  born  and  continued 
until  the  death  or  weaning  of  the  child,  the  former  being  the 
most  common  termination.  When  lactation  ceased  the  desire 
died  away.  Another  case  of  equal  interest  is  reported  in  a 
western  journal.  A  soldier,  wounded  at  Pittsburgh  Land- 
ing, previously  temperate,  became  a  paroxysmal  drunkard. 
A  portion  of  the  shaft  of  the  femor  was  injured,  and  con- 
tinued to  exfoliate  dead  bone  until  1873,  when  it  was 
removed  by  an  operation.  From  the  healing  of  the  wound 
his  drunkenness  disappeared,  and  he  is  now  one  of  the  most 
enthusiastic  of  temperance  men. 

Previous  diseases  are  also  active  causes.  Dipsomania, 
erotomania  or  monomania  often  are  associated  with  epilepsy 
in  some  of  its  obscure  forms,  as  natural  stages  in  its  progress. 
Epilepsy,  with  its  disordered  fancies,  auras  and  impulses, 
ending  in  apparent  recovery,  only  to  be  followed  after  time 
by  a  repetition,  closely  simulates  the  impulsive  drunkard. 


GEJSTEEAI.   PREDISPOSING   CAUSES.  57 

The  connection  between  inebriety  and  epilepsy  is  far  more 
intimate  than  we  are  aware.  Affections  of  the  heart,  either 
organic  or  nervous,  and  low  chronic  hepatitis,  predisposing 
to  hypocliondria  and  melancholy,  very  often  precede  this 
affection.  Neuralgia  often  ends  in  this  way,  by  disturbing 
the  mind  centres  and  its  equilibrium.  Gout  suppressed  has 
brought  on  inebriety,  but  when  it  returned,  drunkenness 
declined.  Intermittent  and  malarious  fevers  have  been  fol- 
lowed by  this  disorder,  and  the  medical  attendant  has  been 
blamed  for  causing  it,  by  prescribing  stimulants.  Persons 
suffering  from  acute  rheumatism,  after  the  severe  symptoms 
have  subsided,  have  exhibited  the  same  affection.  Diseases 
of  the  skin  and  renal  disturbances  have  been  noted  as  pre- 
ceding drunkenness. 

Diseases  of  an  intermittent  character  (a  hint  of  nerve 
complication)  may  be  the  primary  cause  of  drunkenness, 
through  the  perversion  of  functions,  beginning  so  obscurely 
as  not  to  be  noticed. 

Dietetic  diseases  seem  more  frequently  associated  as 
causes  owing  to  the  intimate  association  between  the  nu- 
tritive functions  and  the  nervous  system.  Dyspepsia,  with 
all  its  train  of  perverted  sensations  and  tastes,  have  often 
common  sequence  in  this  disorder.  Excessive  hunger  and 
thirst  are  followed  conditions  vyiiich  are  often  active  causes. 
Indigestion,  inflammation  of  the  stomach  and  liver  often 
leave  a  train  of  predisposing  causes.  Practically,  any 
disease  influencing  or  breaking  up  the  nutritive  functions 
of  the  body,  has  its  first  effect  in  perversions  and  cerebral  dis- 
turbances, of  wliicii  inebriety  is  a  frequent  result.  Indi- 
vidual iiistories  of  neglect  of  hygienic  care,  followed  by 
indigestion,  dyspepsia,  hypochondria,  drunkenness  and 
death,  can  be  traced  in  every  community. 

Exhaustive  intellectual  and  physical  exertion,  by  break- 
ing up  healthy  cerebral  action,  may  develop  insane  longings. 
Over  stimulation  of  the  brain  ends  in  structural  changes 
and  perverted  tastes  for  alcohol  or  narcotics  of  some  kind. 


68  DISEASES    OF   INEBRIETY 

Scholars,  and  tliose  who  use  the  mind  to  excess,  and  laborers, 
who  only  exert  the  physical  system,  when  exliausted  from 
over  work,  have  unnatural  longings  for  something  to  restore 
the  lost  balance  of  mind  and  body.  A  prominent  senator 
spent  thirty  hours  continuously  in  tiie  preparation  and 
delivery  of  a  speech,  and  became  an  inebriate  from  that  time. 
The  proprietor  of  an  ice-house  offered  some  men  large 
wages  to  continue  the  work  of  filling  the  iiouse  ;  being 
expert  workmen  they  continued  without  much  rest  for 
fifty  hours.  Two  out  of  five  became  drunkards,  and  dated 
it  from  this  time. 

Instances  of  similar  character  are  not  uncommon.  Sud- 
den excitement  and  exhaustion  acts  in  the  same  way,  one 
physiological  effect  is  rapid  contraction  of  the  arteries, 
apparent  in  the  pallor  and  consequent  anaemia  of  the  brain. 
The  shock  imparted  to  the  senses  through  the  mind, 
extends  to  the  brain  cells,  producing  similar  commotion, 
often  breaking  up  their  normal  action  forever.  The  sudden 
loss  of  property,  disappoiniment,  trouble,  unrequited 
affection,  may  so  depress  the  vital  powers  and  disturb 
the  circulation,  that  drunkenness  or  insanity,  or  both 
will  follow.  Ambition  to  lead,  wliere  it  becomes  a  domin- 
ant passion,  filling  up  every  moment  of  tliought,  lowers 
the  nutritive  functions  and  leads  directly  to  perver- 
sions of  taste.  Religious  activity,  where  the  mind  over- 
flows with  sentiment  and  emotion,  may  react  into  violent 
gluttonness  or^inebriety.  No  class  of  men  are  so  thoroughly 
dyspeptic  as  clergymen  and  lawyers  ;  simply  the  reaction 
of  the  mind  to  restore  the  equilibrium  broken  up  b}'^  irregu- 
lar exhaustive  labor.  In  every  community  large  numbers 
of  this  class  are  on  the  verge  of  inebriety.  The  capricious 
appetites,  and  the  excessive  thirst  for  tea,  coffee,  cider,  soda, 
lemonade,  etc.,  etc.,  and  the  bitters  and  patent  medicines 
consumed  to  cure  ills  that  are  imaginary,  are  all  early 
stages  of  this  affection  ;  a  change  of  surroundings,  and  they 
become  inebriates  in  the  fullest  sense. 


GENERAL   PREDISPOSING   CAUSES.  59 

Maudsley  thinks  tliat  tlie  depraved  l:>nging's  of  inebriates 
are  greater  in  the  morning,  particularly  if  following  exhaus- 
tion and  anaemia,  owing  to  tlie  contracted  blood  vessels  dur- 
ing sleep,  which  have  not  had  time  to  recover.  Confirming 
this,  a  case  under  my  care  has  strong  cravings  for  liquor  in 
the  morning,  whicii,  if  broken  up,  does  not  return  until  the 
next  day.  This  craving  for  unnutritious  fluids,  or  substances, 
generally  indicates  impending  brain  disorder.  Excentrici- 
ties  of  character  are  frequently  associated  with  inebriety. 
The  poets,  artists,  and  scholars,  and  warriors  of  the  world, 
who  were  inebriates,  are  examples.  Their  minds,  dashing 
beyond  the  bounds  of  normal,  mental  and  physical  life, 
reacts  in  nutritive  excesses.  Of  this  class  we  might  men- 
tion Alexander,  Philip  and  Nero,  among  the  warriors  ; 
Shakespeare,  Byron,  Burns  and  Poe,  of  the  poets  ;  and  John- 
son, Addison,  Pitt,  Sheridan,  etc.,  etc.,  among  the  scholars. 

An  unbalanced  mind  resulting  from  a  misdirected  educa- 
tion is  the  common  cause  of  inebriety.  Where  the  laws  of 
growth  and  elementary  power  are  untaught,  and  the  child 
grows  up  without  any  purpose  or  object  in  life,  the  facul- 
ties undisciplined,  the  appetites  and  tastes  indulged,  no 
system,  only  the  gratification  of  the  physical  wants,  no  par- 
ticular knowledge,  the  love  of  excitement  constantly  stimu- 
lated,and  self-esteem  encouraged,  add  to  all  this,  predomin- 
ant passions,  extravagant  and  capricious  desires,  and  drunk- 
enness is  almost  sure  to  follow.  The  present  system  of 
cramming  and  over-stimulating  children,  in  the  study  of 
imperfect  text  books,  in  worse  surroundings,  lays  the 
foundation  for  both  physical  and  mental  dyspepsia,  hypo- 
chondria and  dipsomania.  Two-thirds  of  our  graduates 
leave  the  schools  with  unnatural  and  perverted  tastes,  feeble 
will-power,  and  ignorant  eccentricities,  strongly  predispos- 
ing them  to  inebriety;  all  they  need  is  the  exciting  cause, 
the  fertile  field  is  prepared  to  receive  it.  The  perpetuity  of 
the  race  depends  upon  the  education  received,  from  both 
school  and  parents.     It  the  child  grows  up  surrounded  witli 


60  DISEASES    OF   INEBRIETY. 

unnatural,  morbid,  influences  and  ignorant  indulgences,  and 
worse  school  education,  its  ruin  is  inevitable.  Under  the 
third  group  are  included  all  those  conditions  and  circum- 
■■*  stances  which  seem  to  particularly  favor  the  development 
of  inebriety.  Of  these,  age  has  a  controlling  influence.  It 
is  well  understood  that  the  body  has  various  stages  of 
development  and  decline.  These  are  really  physiological 
eras  in  the  organization,  whicii  have  prominent  pathological 
relations,  influencing  the  nervous  system,  and  markedly 
controlling  its  disorders.  Statistics  of  the  time  of  life 
when  inebriety  begins,  or  when  the  predisposing  causes  are 
most  active,  are  wanting.  From  an  examination  of  a  large 
number  of  inebriates  at  the  Albany  Penitentiary  and  a 
comparison  of  records  elsewhere,  the  following  facts  seem 
to  be  indicated.  Inebriety  occurs  in  manhood,  or  midway 
between  the  weakness  of  infancy  and  the  decline  of  old  age, 
at  a  time  when  the  brain  has  reached  its  period  of  fullest 
activity.  The  development  of  the  mind  and  nervous  system, 
from  simple  conditions  to  complex  stages,  is  followed  by  an 
increase  of  the  range  of  its  susceptibilities  and  diffusion  of 
its  powers,  and  also  greater  exposure  to  morbid  influences. 
In  adult  life  the  struggle  is  at  its  height,  all  the  faculties 
are  intensely  occupied,  the  fullest  capacity  of  mental  and 
physical  energies  are  exercised.  The  ambitions,  disappoint- 
ments, and  changes  are  sudden  and  far-reaching.  The 
over-weaning  confidence  in  the  physical  and  mental  powers 
of  recovery,  cause  recklessness  of  effects.  Inebriety  appear- 
ing in  adult  life,  may  be  the  result  of  perversions  of  devel- 
opment, beginning  in  infanc)^  Such  cases  are  generally 
associated  with  some  form  of  mental  disease.  The  brain 
power  of  infancy  and  youth,  cannot  bear  much  irritation 
without  peril,  its  circulation  is  more  rapid  and  susceptible 
to  sudden  fluctuations,  which  are  intense  in  their  influence. 
This  is  apparent  in  the  cases  of  permanent  injury,  which 
follows  from  fear,  anger  or  sudden  emotions  that  profoundly 
impress  the  organism.     At  this  time  of  life  organic  changes 


GENERAL   PREDISPOSING   CAUSES.  61 

take  place,  which  have  a  correlative  mental  transformation, 
the  active  degree  of  enervation  existing  makes  the  entire 
body  extremely  susceptible  to  commotions,  in  both  the  or- 
ganic and  mental  developments.  I  believe  tliat  future  ob- 
servations will  indicate  tliat  inebriety  begins  here,  although 
its  development  may  be  delayed  for  years. 

Sex  evidently  brings  certain  influences  which  bear  on 
the  causes  of  this  affection,  although  the  data  are  wanting 
a  few  outline  facts  indicate  an  intimate  relation.  More  men 
are  inebriates  tlian  women,  but  a  large  number  of  the  latter 
are  concealed  by  their  friends;  also  this  affection  merges  into 
otiier  diseases  more  rapidly  than  in  man. 

The  number  of  women  who  have  mental  perversions  is 
very  large,  always  in  excess  of  men.  Generally  women 
suffer  more  keenly  from  inebriety  than  men,  because  they 
have  feebler  organizations,  and  suffer  more  from  functional 
disorders  and  organic  degenerations.  Men  are  more  ex- 
posed to  the  wear  and  tear  of  active  life,  involving  accidents, 
excesses,  wasting  degenerations,  witii  larger  passions  and 
capacities,  and  stronger  nervous  and  mental  organization. 
Women,  vvitli  a  less  vigorous  system,  change  oftener,  and  the 
evolution  is  earlier  ;  the  absorbent  system  and  circulation 
are  more  rapid. 

In  mental  diseases  women  recover  rapidly  if  the  sur- 
roundings are  good,  but  when  functional  and  organic  dis- 
turbances affect  tlie  organism,  the  return  to  health  is 
slower.  Both  sexes  at  puberty,  pass  a  period  of  liigh 
functional  activity,  a  crisis  in  the  organic  and  mental 
growth  of  the  body,  wliich  is  often  the  beginning  of  condi- 
tions resulting  in  inebriety.  At  the  menapause  another 
revolution  comes  over  women,  which  predisposes  to  ner- 
vous defects.  The  close  sympathy  existing  between  the 
sexual  organs  and  the  encephalic  ciiculation,  predisposes 
both  sexes  to  disorders  of  mental  and  functional  character, 
of  wiiich  inebriety  is  prominent. 

Social  condition  has  been  recognized  as  an  active  cause 


62  DISEASES    OF   INEBRIETY. 

in  inebriety  ;  celibacy  predisposes  to  unnatural  and  per- 
verted impulses,  which  rapidly  develop  functional  diseases. 
Married  people  lead  more  natural  and  regular  lives,  and 
their  habits  and  pursuits  are  usually  fixed  and  methodical. 
Home-life  furnishes  sympathy  and  outlets  for  affections 
which  no  otlier  conditions  can  give.  Inebriates  often 
attempt  marriage  as  a  remedy  to  save  themselves  ;  generally, 
inebriety,  beginning  either  before  or  after  marriage,  predis- 
poses to  celibacy.  As  a  rule  inebriates  do  not  marry,  nor 
are  they  true  to  their  vows  after  marriage.  Statistics 
indicate  a  preponderance  of  married  men  as  inebriates,  but 
a  closer  examination  indicates  a  large  proportion  of  them 
leading  single  lives.  Domestic  troubles,  breaking  up  the 
normal  quietness  of  life,  and  sudden  changes  of  conditions, 
from  affluence  to  poverty,  or  vice  versa,  often  bring  on  this 
affection  by  destroying  the  equilibrium  or  co-ordinating 
power.  Social  changes  frequently  drive  men  into  un- 
healthy conditions,  whicli  bring  on  perversions  ending  this 
way.  Fashions  and  customs  develop  unhealthy  mentality, 
which  lead  towards  the  same  affection.  In  many  instances 
we  can  exclude  every  other  cause  but  the  latter,  but  fre- 
quently social  conditions  only  develop  and  excite  latent 
tendencies  to  this  affection.  Future  studies  will  show  that 
the  seasons  and  weather  are  agents,  influencing  more  or 
less  inebriety  and  inebriates. 

The  changes  in  the  organism  from  these  causes  are 
followed  by  corresponding  changes  of  the  mental  condi- 
tions. The  increased  functional  activity  of  the  body  in 
the  spring,  is  supposed  to  favor  the  production  of  mental 
diseases  ;  but  from  the  records  of  police  courts,  penitenti- 
aiies  and  asylums,  inebriety  appears  most  common  and 
acute  in  the  season  of  autumn.  This  has  been  explained 
as  coming  from  moral  and  physical  causes.  The  former 
arising  from  general  failures,  with  blank  prospects,  loss  of 
opportunities,  and  depression  which  follows.  The  latter 
from    physiological    changes,    su'ch    as    thickening   of   the 


GENERAL   PREDISPOSING    CAUSES.  63 

arachnoid,  shriveling  of  the  convolutions,  serous  effusions, 
with  general  atrophy,  and  wasting  of  the  functions. 
Another  fact  well  recognized  is  that  prolonged  cold  and 
rapid  changes  from  one  extreme  to  the  other  particularly 
predispose  to  degeneration  and  morbid  mental  and  func- 
tional activity.  The  effect  of  cold,  driving  the  blood  from 
the  surface,  preventing  proper  contraction  by  congestion  of 
the  cerebral  capillaries  from  reflex  action  explains  this. 
Barometrical  changes  act  in  the  same  way.  Sailors,  sol- 
diers, woodmen,  teamsters,  etc.,  exposed  to  these  conditions, 
are  generally  inebriates,  evidently  due  to  similar  causes. 

All  unhealthy  mental,  physical  and  social  surroundings, 
continuous  excitement,  and  dark,  damp,  low  places  of  resi- 
dence are  noted  for  the  inebriety  which  springs  from 
them.  Whatever  climate  or  season,  combined  with  external 
causes,  checks  or  perverts  the  normal  development  of 
mental  or  physical  life,  becomes  the  exciting  cause  of 
inebriet}'^,  insanity  and  imbecility.  There  are  many  rea- 
sons for  believing  that  future  studies  will  indicate  that 
certain  climates  and  seasons  are  more  favorable  for  the 
treatment  of  inebriety. 

The  temperature  and  condition  of  surroundings  are  evi- 
dently active  causes.  High  degrees  of  heat  and  cold  may 
so  far  impair  the  nutrition  of  the  nerves,  or  produce  paresis 
of  the  vaso-motor  centres,  as  to  result  in  inebriety.  Sun- 
stroke, inflammations,  congestions  and  similar  disorders  of 
the  brain-cells,  coming  from  extremes  of  heat  and  cold,  are 
often  followed  by  drunkenness.  A  fireman  while  overheated, 
took  a  bath  which  resulted  in  severe  headache,  indigestion, 
and  finally  acute  drunkenness.  Here  the  sudden  abstrac- 
tion of  heat  so  damaged  the  nerve-centres,  as  to  bring  on 
this  affection.  The  Captain  of  a  South  American  steamer 
informed  me  that  the  firemen  and  most  of  the  men  em- 
ployed (for  any  length  of  time)  in  this  service,  became 
drunkards  ;  this  he  attributed  to  tlie  extremes  of  climate 
and  heat  which  they  were  constantly  exposed  to.     Leaving 


64  DISEASES    OF    INEBRIETY. 

New  York  in  mid-winter,  within  a  few  days  they  are  in  a 
tropical  temperature,  then  bade  again,  from  the  literal  sum- 
mer of  the  Equator  to  the  frequent  Polar  temperature  of 
New  York,  Inquiry  among  the  furnace-men  of  Albany  and 
Troy  indicates  the  same  fact  ;  men  exposed  to  a  high  heat 
after  a  time  (to  a  large  extent)  became  inebriates. 

The  purity  of  surroundings,  particular!}:  sleeping-rooms 
and  places  of  business,  (without  doubt)  influence  tlie  devel- 
ment  of  inebriety.  Unsanitary  conditions  of  every  descrip- 
tion react  first  on  the  nutritive  functions,  then  on  the  will- 
power. I  believe  further  study  will  show  tliat  the  nutritive 
perversions  of  inebriates  frequently  begin  in  imperfect  oxi- 
dation of  the  blood,  and  the  inhalation  of  noxious  impurities. 
In  this  respect  our  reformatories,  asylums  and  prisons  are 
criminally  wanting.  To  attempt  reformation  or  treatment 
in  damp  cellars,  or  rooms  badly  ventilated,  is  to  ignore  the 
predisposing  causes,  and  fix  and  intensify  the  derangement. 
Cases  are  on  record  of  men  confined  for  a  few  montiis  in  a 
prison,  previously  temperate,  who,  on  coming  out,  became 
furious  drunkards.  The  New  York  State  Prison  Association 
mentions  this  fact,  and  the  explanation  is  evident  in  tlie 
poor  quality  of  food  and  bad  unhealtliy  surroundings, 
strongly  favoring  this  termination.  The  Almsliouses  and 
Poorhouses  of  the  country  furnish  confirmatory  evidence. 
Children  and  young  people  who  have  by  any  misfortune 
been  confined  in  them,  may  be  said  to  have  as  a  rule 
decided  tendencies  to  drunkenness.  Older  people,  past  the 
middle  of  life,  who  come  to  these  places,  go  away  with  the 
same  perversions.  Cellar  occupants  and  those  of  tenement- 
houses  (where  nearly  all  the  conditions  of  health  are  want- 
ing), are  inebriates  as  a  rule  ;  separate  them  from  these 
baneful  influences,  and  reform  or  recovery  follows  naturally 
in  many  cases.  Working  rooms,  such  as  factories  and  shops, 
are  often  nuclei  for  the  same  causes.  Sleeping  and  living 
rooms  may  present  conditions  which  bring  on  disturbed 
nutrition,  and  then  the  train    of  causes  are    put    to  work. 


GENERAL   PBEDISPOSING    CAUSES.  65 

The  sympatliy  between  the  stomach  and  brain  is  so  intimate, 
and  tiie  changes  which  take  place  so  obscnie,  tliat  inebriety 
may  brealv  out  as  tlie  result  of  long  and  continuous  abuses 
of  the  surroundings. 

Mental  diseases  are  found  to  be  largely  controlled  bv 
cosmical  influences,  such  as  Electrical  piienomena,  Lunar 
attractions,  velocities  and  directions  of  winds,  Geoloo-ical 
formations,  elevations  above  the  sea  level,  etc.,  etc.  A 
professional  man  of  great  intelligence,  who  is  an  inebriate, 
becomes  restless,  depressed,  and  has  headache  and  irreo'u- 
larity  of  temper  when  the  wind  blows  from  the  South,  and 
a  storm  is  impending  ;  also  before  a  thunder-storm.  If  he 
can  resist  the  cravings  for  liquor  until  the  storm  is  over 
he  is  safe,  but  if  the  moon  be  at  a  change,  and  the  storm  is 
delayed,  he  loses  all  control  and  lias  a  paroxysm  of  drink- 
ing. At  the  Albany  penitentiary  it  has  been  observed, 
that  chronic  inebriates,  recently  confined,  show  a  decided 
difference  in  work  and  temper  on  the  approach   of  a  storm. 

A  clergyman,  who  was  an  inebriate  in  early  life,  cannot 
go  near  the  seashore,  without  feeling  an  almost  irresistible 
desire  to  drink  again.  On  two  occasions  he, was  obliged  to 
go  back  suddenly  to  the  interior  to  save  himself — a  few 
miles  back  the  desire  leaves  him.  These  cases  indicate  a  wide 
field  of  causes  entirely  unknown.  There  are  influences 
wliich  control  the  wants  of  tiie  body  which  no  one  has  yet 
solved  ;  conditions  of  exaltation  and  depression,  which  we 
all  experience,  of  undefinable  longings  and  tastes,  a  pres- 
sure of  unknown  surroundings,  which  may  perhaps  be 
influenced  by  cosmical  forces.  Certain  districts  of  the  far 
West,  particularly  river-bottoms,  seem  to  present  combina- 
tions of  circumstances  which  end  in  this  affection.  The 
same  may  be  said  of  certain  kinds  of  labor.  The  State 
Board  of  Charity  of  New  York  have  in  their  inquiries 
found  certain  rural  districts  where  pauperism  and  inebriety 
seemed  to  flourish  as  indigenous.  Who  can  predict  what  a 
farther  study  will  disclose  in  this  direction  ? 


CHAPTER   VIII. 

TRAUMATISM   IN   THE   CAUSATION   OF   INEBRIETY. 

From  a  clinical  study  it  will  be  found  that  the  use  of 
alcohol  in  inebriety  is  in  many  cases  only  as  a  symptom,  or 
one  of  the  matu^  causes  that  develop  positive  disease.  It  is 
proposed  in  the  following  study  to  show  that  physical 
traumatism  is  often  an  active  cause  of  inebriety,  which  in 
most  cases  is  not  recognized.  The  early  history  of  drink- 
ing is  often  a  period  of  great  obscurity,  and  the  patient 
himself  will  have  no  clear  idea  of  the  conditions  and  causes 
whicli  impel  him  to  use  spirits.  His  opinions  are  often 
misleading  and  never  reliable  unless  confirmed  by  other 
evidence.  If  he  has  been  taught  to  consider  inebriety  a 
vice  and  sin,  his  ideas  of  the  early  causes  will  be  governed 
by  this  impression.  If  he  has  no  fixed  theories  on  this 
point,  he  will  usually  have  some  notion  of  misfortune  and 
trouble,  and  consequent  despair,  associated  with  the  early 
periods  of  drinking.  From  a  clinical  study  the  views  of 
the  patient  may  be  of  value  as  intimations  of  his  present 
mental  state,  and  the  possible  mental  conditions  which 
have  obtained  in  the  past.  In  all  cases  the  tendency  to 
exaggerate  and  prevaricate,  without  any  ascertainable 
reason,  must  be  considered  in  the  problem  of  diagnosis. 
There  are  two  distinct  periods  in  all  cases  of  inebriety. 
The  first,  beginning  somewhere  in  the  past,  unknown  and 
not  noticeable  to  ordinary  observers,  and  terminating  with 
the  first  excessive  use  of  acohol.  The  second,  starting  from 
this  point  and  noted  by  the  occasional  or  continuous 
66  _      .    . 


TRAUMATISM   IN   THE   CAUSATION   OF   INEBRIETY.  67 

excessive  use  of  spirits,  terminating  only  in  death  or  recov- 
ery. This  period  comes  under  the  observation  of  friends 
and  relatives,  and  can  be  accurately  studied,  and  is 
supposed  to  include  the  entire  field  of  observation.  Inebri- 
ety begins  in  the  first  period,  and  breaks  out  in  the  latter. 
This  first  period  is  not  studied,  it  is  in  the  outer  circle,  the 
penumbra,  or  neurotic  stage. 

The  second  period  is  the  umbra,  and  inebriate  stage. 
In  this  first  or  neurotic  stage,  the  causes  and  conditions 
are  as  varied  and  complex  as  that  which  produces  insanity. 
Notwithstanding  their  obscurity,  they  often  present  distinct 
intimations  of  inebriety  far  in  advance.  Every  case  will  be 
found  to  come  from  some  special  condition  of  change  or 
departure,  from  healthy  activity  in  the  organism,  in  which 
both  the  function  and  structure  are  involved.  Even  in  this 
early  stage,  a  certain  progressive  march  may  be  noted, 
often  broken  by  long  obscure  halts,  or  precipitous  strides, 
changing  into  varied  forms  and  manifestations  of  disease. 
This  neurotic  stage  will  be  marked  in  most  cases  by  nerve 
exhaustion,  instability  of  nerve  force,  and  nutrient  per- 
versions and  disturbances.  Not  unfrequently  delusions 
and  hallucinations  about  foods  and  drinks  are  unmistakable 
symptoms.  Often  persons  who  have  never  used  spirits, 
and  become  fanatical  in  their  efforts  to  reform  inebriates, 
are  in  tliis  stage,  and  sooner  or  later  glide  into  the  next 
one.  Tliese  are  the  general  indications,  associated  with 
innumerable  minor  hints  and  symptoms,  that  follow  from 
all  the  degrees  of  inheritance,  occupation,  surroundings, 
and  all  conditions  which  make  up  physical  and  mental 
health.  Traumatism  may  bring  the  patient  into  the  first 
stage,  or  into  the  second  at  once.  Or  it  may  leave  him 
susceptible  to  every  piiysical  state  and  surroundings. 
Psychical  traumatism,  or  injury  from  mental  agitation  or 
powerful  emotions,  as  a  cause  of  inebriety,  may  be  con- 
sidered from  two  points  of  view.  First,  as  a  direct  cause  of 
inebriety,  and  second,  as  an  indirect  cause,  by  developing 


68  DISEASES    OF   INEBRIETY. 

conditions  which  rapidly  merge  into  tliis  disorder.  As  a 
direct  cause  tlie  following  case  is  a  good  illustration  : 

A  merchant,  previously  healthy  and  temperate,  forty-five 
years  old,  with  no  neurotic  inheritance,  was  returning  from 
New  York  City  (wliere  he  had  been  on  business),  on  an 
evening  train,  on  tiie  Hudson  river  railroad.  Wiiile  moving 
at  great  speed  the  cars  jumped  the  track,  and  ran  along  on 
the  sleepers  for  some  distance  before  they  were  stopped. 
The  sudden  alarm,  crashing  of  the  windows,  and  profound 
agitation  from  fear  of  death,  produced  functional  paraly- 
sis, and  he  had  to  be  lifted  out  of  the  car.  He  was  taken 
to  a  farm-house,  and  after  a  few  days  was  able  to  go  home, 
but  complained  of  exhaustion  and  neuralgic  pains  all  over 
the  body.  He  began  to  use  alcohol  to  intoxication  and 
could  give  no  reason  why  he  drank.  This  continued  for 
three  years,  until  death  from  pneumonia  brought  on  by 
exposure  while  intoxicated.  Notwithstanding  all  the  efforts 
of  himself,  relatives  and  family,  he  drank  precipitately  to 
the  latest  moment  of  life.  He  began  to  drink  soon  after 
the  injury,  calling  for  it  with  g'-eat  urgency.  At  first  it 
was  freely  given,  until  he  was  so  often  under  the  influence 
that  it  had  to  be  removed. 

The  second  case  of  this  character  was  that  of  a  clergy- 
man who  was  in  good  health,  a  man  of  strong  temperance 
scruples,  and  very  correct  in  all  his  habits.  The  sudden 
death  of  his  wife  from  a  railroad  accident,  threw  him  into  a 
nervous  fever,  that  lasted  for  two  weeks,  after  which  he 
began  to  use  spirits  in  large  quantities.  He  claimed  that 
he  needed  it  for  exhaustion  as  a  tonic,  and  justified  his 
use  of  it  to  intoxication.  From  this  period  he  drank  at 
all  times  and  places,  giving  no  cause  or  reason  for  its  use 
except  that  of  a  medicine.  He  was  soon  discharged  from 
the  church,  and  became  an  outcast  and  inebriate  of  the 
lowest  grade.  He  is  now  serving  out  a  sentence  for  assault 
in  state's  prison.  His  inebriety  began  directly  from  the 
shock  following  or  caused  by  intense  sorrow  and  grief. 


TRAinviATrsM:  in  the  causation  of  inebriety.         69 

In  both  of  these  cases  there  was  a  degree  of  mental  and 
physical  vigor,  that  gave  no  indications  of  tliis  sequel,  or 
any  neurotic  disease.  There  was  no  heredity  in  either  case 
that  was  prominent,  and  the  inebriety  was  purely  from  psy- 
chical traumatism. 

There  is  another  class  of  cases  which  not  only  have  a 
general  neurotic  inheritance,  but  have  hints  of  defective 
nerve  force  long  before  traumatism  brings  on  inebriety. 
The  following  cases  bring  out  these  facts  clearly  : 

A  lawyer,  age  forty-four,  who  was  a  temperate  hard- 
working man,  was  made  unconscious  by  a  stroke  of  liglit- 
ning,  and  from  recovery  began  to  use  large  quantities  of 
spirits  at  night.  He  became  an  inebriate  and  died  three 
years  after  from  delirium  tremens.  His  grandfather  on  his 
mother's  side  died  from  inebriety,  and  two  uncles  were 
inebriates.  His  mother  used  spirits  freely  as  a  medicine 
for  many  years.  Here  it  was  clear  that  an  inebriate 
diathesis  existed,  and  was  only  developed  or  exploded  by 
the  traumatism. 

A  farmer,  who  was  temperate,  had  suffered  some  years 
from  nervousness  and  general  liypochondria,  was  greatly 
excited  at  the  burning  of  his  barns,  supposed  to  be  the 
work  of  an  enemy.  He  was  laid  up  in  bed  for  two  days, 
then  began  to  drink  brandy,  and  was  intoxicated  from  this 
time  to  death  nearly  every  day.  Tiiere  was  no  clear  history 
of  heredity,  but  iiis  nervousness  and  hypochondria  seemed 
to  follow  from  some  disorder  which  began  at  puberty. 
Some  nerve  defect  liad  lessenea  tlie  vigor  and  integrity  of 
the  organism,  and  tlie  traumatism  followed,  bringing  out 
inebriety. 

Another  case  has  lately  cd^ne  under  my  care  of  a  mer- 
chant, who  had  been  well  and  temperate  up  to  his  business 
failure.  This  came  upon  him  unexpectedly,  and  caused 
great  mental  anguish,  follow  by  impulsive  inebriety.  He 
could  give  no  reason  for  his  drinking,  and  simply  said  it 
was    impossible   to  abstain.     His   history,   for  some  years 


70  DISEASES    OF   INEBRIETY. 

befoie  the  failure,  indicated  chronic  dyspepsia  and  general 
perversion  of  nutrition,  altliough  he  had  conscientiously 
refrained  fi'om  all  use  of  spirits,  yet  liis  capricious  nutritive 
impulses  exploded  readily  into  inebriet}'  from  tlie  action  of 
traumatism. 

There  are  many  reasons  for  supposing  that  all  cases  of 
this  character,  where  dyspepsia  and  nutrient  disturbances 
exist  for  some  time,  are  peculiarly  susceptible  to  traumatism, 
particularly  of  psychical  character.  The  same  may  be  said 
of  a  large  class  who  have  inherited  unstable  brain  and 
nerve  forces,  either  from  inebriety,  insanity,  or  any  other 
organic  disease.  They  are  all  more  susceptible  to  trauma- 
tism and  his  results. 

All  these  cases  proceeded  directly  from  psychical 
traumatism.  Whether  the  traumatism  broke  up  the  co-or- 
dinating nerve  centers,  which  are  supposed  to  govern  the 
sensation  of  thirst,  or  produced  some  general  exhaustion 
of  these  and  other  centers,  which  found  in  alcohol  a  seda- 
tive, cannot  at  present  be  determined.  The  desire  for 
alcohol  in  all  these  cases  is  only  a  symptom  of  some  general 
nerve  degeneration,  which  has  been  produced  by  trauma- 
tism. In  the  second  class  of  cases,  where  psychical  trauma- 
tism is  the  cause  of  inebriety  indirectly,  the  histor}''  and 
symptoms  are  alwavs  more  or  less  obscure,  and  require 
careful  study.  Yet  these  cases  are  undoubtedly  numerous, 
and  will  in  the  future  attract  much  attention.  The  follow- 
ing cases  are  fair  illustrations  : 

A  banker,  in  middle  life,  in  good  health  and  strictly 
temperate,  W'as  greatly  shocked  at  the  death  of  his  father 
from  heart  disease  while  at  the  table.  For  several  weeks 
lie  suffered  from  insomnia, tind  could  not  concentrate  his 
mind  on  anything,  was  nervous  and  complained  of  dull 
headache.  He  was  under  treatment  for  a  long  time  with- 
out any  positive  results.  Nearly  a  5'^ear  after  he  suddenly 
drank  to  intoxication,  and  from  this  time  went  rapidly 
down  to  hopeless  inebriety.     There  was  no  heredity  and  no 


TRAUMATISM   IN   THE    CAUSATION   OF   INEBRIETY.  Tl 

ill-health  up  to  this  time.  Some  shoclc  liad  been  sustained 
by  tlie  nerve  centers  which,  from  tlie  application  of 
unknown  causes,  burst  out  into  inebriet3\ 

A  lawyer  whose  fatlier  had  suffered  from  general  paraly- 
sis, suddenly  became  an  inebiiate  at  twenty-four  years  of 
age,  under  circumstances  and  surroundings  that  were  tlie 
most  adverse.  After  a  long  study  it  was  ascertained  tliat 
he  had  been  profoundly  agitated  from  tlie  refusal  of 
marriage  with  a  lady,  who  soon  after  married  a  rival. 
Tliat  for  a  long  time  he  was  treated  by  a  physician  for 
threatened  brain  fever,  and  that  he  never  recovered  liis 
former  vigor  and  cheerfulness.  Three  years  after  he 
married  into  a  fine  family,  and  had  every  agreeable  sur- 
rounding possible,  when  suddenly  he  rushed  into  a  low 
saloon  and  drank  to  intoxication  for  the  first  time.  He 
seemed  to  try  and  help  himself,  but  every  day  sank  lower 
and  lower,  and  was  finally  divorced  from  his  wife  and  cast 
adrift  a  hopeless  incurable.  The  same  psychical  causes 
were  at  work  beginning  in  the  shock  from  disappointment, 
and  slowly  slumbering  along  until  inebriety  developed. 

A  farmer  with  no  heredity  of  nerve  disease,  temperate 
from  principle  and  a  hale,  vigorous  man,  was  greatly  pros- 
trated by  grief,  while  on  a  visit  to  tlie  army, to  find  that  his  son 
had  been  killed  in  battle.  For  five  years  after  he  complained 
that  he  did  not  feel  well,  could  not  sleep  soundly,  was  more 
easily  exhausted  than  ever  before,  and  suffered  from  neural- 
gia and  changing  sensations.  One  day,  in  tlie  harvest  field, 
he  left  his  work  and  drove  off  to  a  distant  city,  drinking  to 
intoxication.  Ever  after  he  drank  all  the  time,  with  every 
opportunity  and  occasion.  His  excuse  was  that  he  had  a 
tape  worm,  which  had  been  taken  into  the  system  when  he 
was  in  the  army.  Like  the  other  cases  the  effect  of  grief 
and  consequent  shock  produced  some  permanent  alteration 
of  both  structure  and  function  ending  in  inebriety.  The 
cases  were  also  noted  by  the  absence  of  any  stage  of 
moderate  drinking,  and  the  sudden  onset  of  the  excessive 


72  DISEASES   OF   INEBRIETY. 

use  of  alcohol.  Quite  a  large  class  after  some  form  of 
psychical  traumatism  have  a  stage  of  moderate  drinking, 
which  very  commonly  ends  in  impulsive  inebriety,  that 
comes  on  unexpectedly.  The  following  are  some  cases, 
whose  origin  and  history  are  very  clear   in  many  instances  : 

A  strong  temperance  advocate  and  lawyer  of  culture,  in 
vigorous  health,  was  involved  in  a  stock  company  that 
ruined  his  reputation,  by  an  accident  in  which  he  was  not 
in  any  way  guilty.  He  suffered  so  keenly  that  he  was 
treated  for  fever,  which  lasted  some  weeks,  then  he  resumed 
business.  Later,  he  began  to  use  bee*"  in  moderation  for 
debility,  and  this  in  a  year  or  more  merged  into  stronger 
drinks  at  night.  Another  year,  and  he  suddenly  began  to 
drink  to  intoxication  every  day,  soon  losing  his  business 
and  becoming  a  hopeless  incurable.  From  the  time  of 
failure  of  tlie  company  and  his  reputation,  a  steady  decline 
of  mind  and  body  was  apparent.  No  special  symptoms 
could  be  recognized  that  pointed  to  other  than  general 
failure  of  his  former  vigor  and  pride  of  character.  Some 
change  had  taken  place,  and  something  was  wanting  to 
make  up  health  and  integrity  of  organism. 

A  second  case  was  an  engineer,  with  no  history  of  hered- 
ity, and  a  man  of  fine  health  and  thoroughly  temperate. 
While  at  his  work  in  the  field,  a  gun  in  his  hands  w^as 
accidently  discharged,  killing  an  intimate  friend  and 
brother  engineer.  He  was  greatly  depressed  and  melan- 
choly for  months,  at  times  would  burst  out  into  tears,  and 
be  unable  to  work  ;  then  he  began  to  use  spirits  at  night  to 
bring  on  sleep,  and  a  few  montiis  after  he  drank  to  excess 
and  was  obliged  to  give  up  his  business.  He  died  a  year 
later  from  excessive  use  of  spirits. 

A  third  case,  equally  free  from  all  entailment  of  disease, 
and  well  up  to  the  time  of  great  exposure  and  excitement 
from  the  loss  of  his  mill  by  a  freshet,  began  to  use  spirits 
for  exhaustion  and  debility,  and  a  few  months  later  was  a 
pronounced   inebriate,  drinking  all   the   time.     It  may   be 


TRAUMATISM   IN   THE    CAUSATION    OF   INEBRIETY.  73 

asked  if  these  cases  gave  indications  of  inebriety  following 
the  traumatism  ?  The  answer  is  that  the  period  of  moder- 
ate drinking  showed  this  tendency  clearl3\  It  could  not  be 
an  accident,  for  all  of  these  cases  were  men  that  were  fully 
aware  of  the  danger  of  such  a  course,  and  would  not  enter 
upon  it  unless  impelled  by  a  diseased  impulse  which  they 
could  not  control. 

It  is  exceedingly  difificult  for  tliose  not  practically 
acquainted  with  business  life  to  understand  the  constant 
strain  and  excitement  which  follows  all  business  and  pro- 
fessional activity.  From  the  poorest  laborer  to  the  million- 
aire and  professional  man  of  the  widest  influence,  there  is 
a  hurry  and  excitement,  and  a  want  of  rest,  that  is  steadily 
preparing  the  soil  for  all  forms  of  nervous  diseases.  Tiie 
rivalry  and  intensity  of  school  life  follows  the  child  to  the 
grave.  In  business,  in  a  profession  or  farming,  it  is  the 
same  struggle  for  prizes  ;  gathering  up  all  the  energies  of 
body  and  mind  and  concentrating  them  in  one  effort  ;  if 
they  fail,  turning  to  some  other  field  with  the  same  intensity 
and  courage.  A  prominent  professor  in  a  leading  medical 
college  and  author  of  note,  has  been  a  teacher  of  languages, 
a  mercliant,  an  inventor,  a  mining  engineer,  all  within  a 
career  of  less  than  half  a  century.  These  extreme  changes 
of  life  and  occupation  strongly  predispose  the  person  to 
states  of  exhaustion,  or  as  the  late  Dr.  Beard  wrote  :  "  We 
are  a  nation  of  neurestlienics  out  of  which  many  and  com- 
plicated nervous  diseases  are  constantly  springing." 

Psycliical  traumatism  will  appear  oftener  as  a  promin- 
ent factor  in  tiie  causation  of  inebriety  here  than  elsewhere. 
The  following  cases  are  typical  of  a  class  that  represents 
one  extreme  of  American  life,  tlie  speculators  and  brokers  : 
A  broker,  witli  no  history  of  heredity,  healthy  and  temper- 
ate, who  liad  made  and  lost  two  fortunes,  and  was  rich 
again,  entered  into  a  pool  and  sunk  every  dollar.  His  wife 
was  taken  ill,  and  he  was  forced  to  leave  his  old  home,  and 
have  her  taken  to  the  hospital,  wiiere   she  died   soon   after. 


74  DISEASES    OF*   INEBRIETY. 

He  began  to  use  spirits  to  gi-eat  excess  at  once  and  is  now 
a  chronic  inebriate.  The  shock  from  tlie  last  misfortune 
brouglit  on  inebriety,  and  although  he  made  many  efforts 
to  recover  he  always  drops  lower  from  the  struggle. 

A  banker  who  had  made  a  large  fortune,  became  a 
speculator  and  went  into  Wall  street.  He  was  very  correct 
in  all  his  habits  of  living  and  was  careful  of  his  body.  For 
ten  years  he  both  made  and  lost  large  sums  of  money,  and 
was  under  the  usual  strain  of  men  who  embark  their  for- 
tunes in  one  venture.  His  son,  who  was  expected  to  follow 
in  the  same  business,  proved  a  defaulter,  and  was  sent  to 
state's  prison.  The  father  began  to  drink  to  great  excess  at 
once,  and  died  after  three  months  of  extreme  drinking.  In 
cases  of  this  character  there  must  be  a  condition  of  great 
exhaustion  and  general  debility  which  gives  way  under  the 
last  shock  of  traumatism. 

The  following  cases  represent  another  extreme  of  life  in 
this  country.  A  farmer  who  had  for  twenty  years  worked 
early  and  late,  eaten  poor  food,  depriving  himself  of  many 
necessities  and  comforts  of  life,  that  he  might  own  his 
farm,  was  plunged  into  the  deepest  distress  on  finding  tiiat 
the  title  was  wrong,  and  all  his  labors  had  been  lost.  He 
drank  at  once  to  excess,  and  a  year 'after  was  taken  to  an 
insane  asylum.  He  was  discharged  in  a  few  montiis,  but 
continued  to  drink. 

A  bookkeeper  worked  night  and  day  in  an  absorbing 
passion  for  wealth,  neglecting  to  rest  and  taking  but  little 
outdoor  exercise.  His  position  and  investments  were  all 
swept  away  by  a  financial  storm,  and  he  became  an  inebii- 
ate  at  once.  Later  he  was  a  bar-keeper,  then  was  sent  to 
prison  for  some  crime.  The  usual  explanation  would  be 
that  these  cases  drank  from  despair  and  discouragement, 
but  a  general  study  will  show  a  state  of  psychical  pain  and 
agony  for  whicli  alcohol  alone  acts  as  a  sedative.  It  very 
commonly  appears  in  a  study  of  cases  of  inebriety,  that  the 
[latient  will  refer  to    some    event  of  life,  or    disease,  from 


TEATTMATISM   IN    THE    CATTSATION    OP   INEBKIETT.  75 

which  he  lost  some  power  or  force  whicli  lie  lias  never  re- 
gained. Such  facts  are  not  given  as  reasons  for  his  diink- 
ing,  but  as  explanations  of  his  vigor  or  power  of  endurance. 
One  man  gives  a  history  of  overwork  under  conditions  of 
great  mental  excitement  from  which  he  has  never  recovered 
his  former  vigor.  Years  after  he  becomes  an  inebriate,  but 
he  never  traces  the  connection  between  tlie  former  overwork 
and  the  inebriety.  A  careful  inquiry  will  show  many  hints 
along  this  interval  (which  may  be  years),  that  refer  directly 
to  this  event,  showing  that  inebriety  is  but  the  result  of 
degenerations  whicli  begun  there.  In  another  case  a  man 
suffers  from  some  profound  grief  and  sorrow,  which  at  the 
time  breaks  up  his  health,  and  for  a  long  time  after  is  felt 
in  general  debility  and  weakness.  Years  go  by,  and  sud- 
denly he  drinks  to  intoxication,  and  is  an  inebriate  at  once. 
No  good  reason  can  be  given  for  drinking,  and  possibly  no 
stage  of  moderate  use  of  spirits  precedes  the  inebriety.  To 
himself  and  friends  a  degree  of  ill  health  has  been  recog- 
nized from  the  time  of  his  great  grief,  and  to  the  physician 
who  can  study  closely  this  interval,  there  will  be  found 
nutrient  perversions,  neuralgia,  eccentricities,  and  nameless 
indications  of  a  coming  storm. 

A  very  large  class  of  cases  have  in  the  past  suffered 
from  some  form  of  disease  from  which  they  have  recovered 
with  an  entailment  of  debility,  and  a  want  of  something 
that  cannot  be  defined.  They  are  fully  conscious  of  dimin- 
ished power,  of  change  of  vigor  and  force.  It  may  be  they 
do  not  sleep  as  naturally,  and  do  not  get  the  usual  rest  ;  or 
they  do  not  recover  so  quickly  when  exhausted,  cannot 
digest  food  as  thoroughly,  have  dyspepsia  from  sliglit 
causes.  They  are  more  sensitive  than  before,  emotional 
and  excitable  witli  every  event  that  is  irritating. 

In  one  case  a  man  has  a  severe  pneumonia  with  a  tedious, 
long  convalescence.  After  recovery,  a  change  of  disposi- 
tion and   character  is   noticed,  and    a  year   or  so  after    he 


^S  DISEASES    OE   USTEBRIETY. 

begins  to  drink  spirits  and  soon  becomes  an  inebriate.  Or 
another  case  where  a  man  recovers  from  typhoid  fever,  and 
for  a  long  time  exliil)its  marked  alterations  of  liabits  and 
ciiaracter,  then  suddenly  or  gradually  becomes  an  inebiiate. 
There  can  be  no  doubt  that  inebriety  originated  in  the 
traumatism  following  the  diseases  in  these  cases.  Some 
special  exciting  cause  favored  its  development,  or  possibly 
the  injury  done  to  the  nerve-centers  would  only  manifest 
itself  in  tliis  way.  The  first  causes  are  traumatic,  following 
the  diseases  or  lesions  which  take  place,  particularly  notable 
in  the  complex  range  of  psychical  symptoms  that  are  seen. 
The  integrity  of  tlie  organism  and  function  has  been 
impaired,  and  from  this  point  disease  and  diseased  ten- 
dencies are  developed. 

These  cases  are  found  in  every  community,  and  of 
course  do  not  all  become  inebriates,  but  like  a  large  class 
of  eccentrics  are  on  the  border  line,  or  inner-circle  shading 
into  inebriety  or  insanity.  A  large  number  of  persons 
engaged  in  the  late  civil  war,  who  suffered  hardship  and 
mal-nutrition,  became  inebriates  years  after,  following  the 
psychical  and  physical  traumatism  received  at  that  lime. 
The  effects  of  commercial  disasters,  of  bankruptcies,  and 
panics  in  Wall  street,  can  be  seen  in  inebriate  or  insane 
asylums. 

In  the  asylum  at  Binghamton,  New  York,  for  inebriates, 
at  one  time  were  eighteen  cases,  whose  inebriety  could  be 
clearly  traced  to  a  great  money  panic  in  Wall  street,  known 
as  the  "  Black  Friday."  Many  of  these  cases  were  purely 
from  psychical  traumatism,  others  were  already  in  the  dark 
circle  close  to  inebriety,  and  needed  but  a  slight  cause  to 
precipitate  them  over.  Political  failures  are  also  fertile 
fields  for  the  growth  of  inebriety  and  the  action  of 
psychical  influences.  Annually  a  large  class  after  the  close 
of  a  campaign  find  themselves  literally  inebriates,  and  if 
they  have  money  go  to  water-cui-es,  inebriate  asylums,  or 
to    the   far  west    and   begin    life    again.     The    inebriety    is 


TRAUMATISM   IN   THE   CAUSATION   OF   INEBRIETY.  77 

often  of  a  paroxysmal  or  dipsomanical  type,  with  free 
intervals  of  sobriety,  that  give  renewed  energy  to  the 
delusive  hope  tliac  recovery  will  follow  the  bidding  of  the 
will.  A  class  of  moderate  or  occasional  drinkers  are 
always  more  susceptible  to  these  influences  than  abstainers. 
This  was  marked  in  an  instance  where  three  men,  two 
moderate  drinkers  and  one  abstainer,  partners  in  business, 
witli  equal  capital,  lost  it  all  in  one  night.  The  abstainer 
recovered  and  resumed  again,  the  moderate  drinkers  both 
drank  to  excess  after,  and  died  inebriates.  It  may  be 
stated  as  a  rule  tliat  moderate  drinkers  suffer  more  fre- 
quently from  psychical  shocks  of  every  form,  and  are  more 
likely  to  become  inebriates  from  such  causes.  The 
inebriety  that  follovvs  directly  or  indirectly  from  psychical 
traumatism,  differs  in  natural  progress  and  history  from 
other  cases.  The  physical  degenerations  are  more  pro- 
nounced, the  heart  and  liver  take  on  organic  disease 
quickly,  and  the  mental  symptoms  are  prominent.  In 
some  cases  the  course  of  the  disease  is  paroxysmal,  and 
the  mental  degenerations  are  suspicious  of  what  is  called 
moral  insanity.  As  in  the  following  :  A  commercial 
traveler  in  good  health,  and  a  man  of  character,  became  an 
inebriate  dating  from  a  steamboat  accident  in  whicli  he 
was  greatly  alarmed,  and  barely  escaped  being  both  burned 
and  drowned.  When  not  drinking  he  planned  and  exe- 
cuted deceptions,  cheated  his  employers,  and  engaged  in  a 
course  of  crime  and  villainy  that  was  without  shrewdness, 
and  entirely  foreign  to  all  his  past  history.  He  was  sent 
to  prison  and  died  from  consumption.  In  another  case,  a 
merchant,  after  the  onset  of  inebriety  from  the  same 
psychical  influences,  suddenly  became  a  gambler,  and 
frequented  the  lowest  places  of  this  class. 

In  the  treatment  of  these  cases,  where  the  previous 
history  has  been  concealed  or  not  ascertained,  the  impulsive 
boasting  and  foolish  prevarications,  and  efforts  to  cover  up 
and  live  a  double  life  by  pretending  to  use  all  means  for 


78  DISEASES   OF   INEBRIETY. 

recovery,  and  steadily  thwarting  them,  are  often  clear  hints 
of  psychical  traumatism,  which  a  more  accurate  history 
confirms.  Want  of  space  prevents  us  from  illustrating  this 
subject  further.  Any  general  study  of  inebriety  will  point 
out  this  factor  of  traumatism  as  prominent  in  many  cases 
that  are  now  unknown.  The  following  conclusions  may 
serve  as  a  guide  to  other  studies  in  this  field,  or  as  hints  of 
the  rich  mines  for  clinical  and  psychological  investigation 
awaiting  future  discovery. 

1.  The  injury  to  the  nerve-centers  from  psychical 
traumatism  is  the  literal  switch  or  point  of  departure  from 
the  main  line,  from  which  all  subsequent  disease  and 
symptoms  of  change  and  perversion  can  be  traced  and 
studied. 

2.  The  most  prominent  early  symptom  is  exhaustion  or 
neuraesthenia,  which  goes  on  progressively  manifest  in 
more  complex  deviations  from  health,  and  general  func- 
tional disturbances. 

3.  This  may  explode  into  inebriety  at  once,  or  appear  in 
moderate  drinking,  which  will  always  end  in  inebriety. 
The  type  of  this  ci'aving  will  differ  from  others  in  the 
extreme  mental  degeneration  which  follows. 

4.  The  prognosis  and  treatment  will  differ  materially, 
depending  on  a  knowledge  of  these  facts,  and  will  present 
indications  that  are  absolutely  necessary  to  know  in  the 
proper  management  of  the  case. 


CHAPTER   IX. 

CAUSES  CONTINUED.  ADVERSITY,  ETC.,  ETC. 

The  disease  of  inebriety  has  in  many  cases  a  distinct 
prodromic  stage  of  moderate  drinking.  In  a  certain  num- 
ber of  instances  the  disease  never  goes  beyond  this  stage. 
Death  follows  from  some  intercurrent  affection,  always 
influenced  by  the  state  caused  by  alcohol.  Moderate  use  of 
alcohol  in  a  healthy  man  is  always  injurious,  and  is  the 
initial  stage  of  inebriety,  whether  it  goes  on  to  full  devel- 
opment or  not.  All  cases  of  inebriety  are  either  preceded 
by  tills  early  stage  of  moderate  drinking,  or  appear  sud- 
denly as  the  result  of  certain  conditions  more  or  less 
unknown.  In  the  latter  case  injuries  of  all  kinds  are  the 
most  frequent  causes.  But  in  the  former,  the  soil  favorable 
for  inebriety  is  already  prepared,  and  slight  exciting  causes 
are  sufficient  to  bring  on  full  development. 

Adversity  witli  its  mental  depression  and  tendency  to  mel- 
ancholy, also  general  lowered  mental  and  physical  activity, 
are  among  the  active  causes  which  precipitate  the  moderate 
drinker  into  full  inebriety.  Clinical  experience  brings  abun- 
dant proof  of  this  statement.  On  physiological  grounds  it 
is  clear  that  moderate  drinkers  have  less  resisting  power  to 
disease  or  change,  which  involves  exhaustion  of  the  nerve- 
centers,  and  changes  of  brain  force.  The  use  of  alcohol 
has  intensified  the  very  state  of  debility  which  it  is  sup- 
posed to  remedy,  always  masking  and  covering  up  the  real 
condition.  When  a  special  demand  is  made  on  the  system, 
this  mask  is  thi"own  off  and  inebriety  appeal's. 

Clinically,  a  class  of  moderate  drinkers  who  are  intently 

79 


80  DISEASES    OF    INEBRIETY. 

absorbed  in  some  pursuit  or  ambition,  in  which  great 
interests  are  involved,  become  inebriates  as  a  rule  from 
adversity.  They  are  neuraesthenic  both  from  the  use  of 
alcohol  and  general  perversions  of  tlie  nervous  system  con- 
sequent upon  over-work  and  mental  anxiety.  Hence,  when 
the  increased  strain  from  the  changed  conditions  of  adver- 
sity comes  on,  alcohol  is  taken  as  a  narcotic  and  gives 
relief. 

Another  class  of  persons  are  noted  clinically  by  their 
weak,  exhausted  nerve  condition,  and  general  instability  of 
mind  and  body.  Adversity  frequently  precipitates  this 
class  into  inebriety.  They  are  always  predisposed  to  this 
affection,  and  tlie  use  of  alcohol  as  a  stimulant  is  so  com- 
mon, and  its  effects  are  misleading,  that  they  quickly  fall 
into  chronic  stages  of  inebriety.  The  nerve-centers  are  in 
a  condition  of  starvation  from  over-work  and  defective 
nutrition.  Alcohol  constantly  increases  tliis  state,  and 
hushes  the  agonized  cries  of  nature  for  relief. 

In  the  observation  of  every  one  are  found  cases  who 
have  been  moderate  drinkers  up  to  some  great  trouble  or 
adversity,  then  become  inebriates.  Anotlier  class  are 
noticed  of  intensely  nervous  persons,  who  are  not  known  as 
moderate  drinkers,  up  to  some  period  of  profound  shock 
or  adversity,  which  changes  and  alters  the  entire  mental  or 
physical  life.  From  this  time  inebriety  springs  up  suddenly 
and  generally  progresses  with  great  intensity.  In  the 
former  case,  adversity  was  the  active  exciting  cause,  kindling 
into  energy  conditions  whicli  may  have  been  gathering  for 
a  long  time.  In  the  latter,  it  explodes  a  state  of  nerve 
exhaustion,  in  the  direction  of  inebriety.  Adversity,  while 
depressing  some  men,  destroying  all  energy  and  faith  in  any 
further  exertion,  has  the  opposite  effect  on  others,  rousing 
them  to  greater  endeavors,  which  if  buoyed  up  on  alcohol, 
must  fail  in  the  future.  Tiie  ph3'sician's  frequent  prescrip- 
tion of  alcohol  in  cases  of  debilit}''  following  mental  trouble 
and  sorrow,  is  always  full  of  peril  to  the  patient.     At  this 


CAUSES    CONTINUED,    ADVERSITY,    ETC.  81 

time  the  danger  of  inebriety  is  very  great,  and  cannot  be 
over-estimated.  Those  who  liave  previously  used  spirits  in 
moderation,  should  never  have  it  as  a  medicine  for  any 
general  disorder  marked  by  nerve  depression. 

Those  who  liave  been  temperate,  and  suffer  from  great 
physical  and  psychical  disorder  consequent  on  changes  of 
external  conditions,  following  adversity,  cannot  take  alcohol 
without  great  danger  of  inebriety. 

Adversity  has  been  recognized  for  a  long  time  as  preced- 
ing inebriety.  The  general  fact  has  been  often  noted,  that 
long-continued  adversity  in  any  community  will  produce 
more  or  less  insanity. 

The  same  condition  of  adversity  is  followed  more  fre- 
quently by  inebriety,  which  fact  can  be  shown  in  the  history 
of  every  community. 

Inebriety  is  a  common  sequel  gnd  physiological  out- 
growth of  adversity.  All  moderate  drinkers  are  practically 
inebriates  in  the  early  stages,  and  liable  any  moment  to 
develop  extreme  symptoms  or  stages  of  this  disease. 

It  may  be  said  tliat  the  use  of  alcohol  in  all  cases  of 
nerve  and  brain  debility,  either  from  mental  or  physical 
depression,  is  dangerous  and  likely  to  bring  on  inebriety. 

Neurasthenia  is  rather  the  comparatively  permanent 
exhaustion  which  is  the  result  of  prolonged  over-strain, 
mental  or  physical,  or  botli,  too  little  rest,  insufficient  or 
defective  nourishment,  long  continued,  until  the  substance 
of  the  nervous  system,  and  often  of  the  blood  which 
nourishes  it,  is  wasted  or  worn  away  far  below  healthy 
limits,  entailing  as  a  necessary  consequence  a  correspond- 
ing/c^j'i"  ^y /z^rz/^/t'Zf'^r  and  in  most  cases  morbid  exaltation  of 
the  seftsibility,  not  to  speak  at  present  of  other  important 
though  auxiliary  elements  of  such  cases.  Neurasthenia  may 
be  exhibited  in  the  sphere  of  the  mind  as  in  weakness  of 
thought,  but  especially  weakness  and  vacillation  of  will, 
or  in  other  words,  loss  of  control  and  lack  of  decision  ;  in 
unduly  excitable  and  unhealthy  emotions,  generally   of  a 


82  DISEASES   OF   INEBRIETY. 

distressing  or  depressing  character  ;  or  in  the  sphere  of  the 
simple  physiological  activities,  especially  in  feebleness  and 
irregularity  of  muscular  action  ;  exaltation  of  physiological 
sensibilities  of  any  or  all  kinds,  but  especially  reflex  excita- 
bility ;  the  circulation  of  tiie  blood  is  also,  as  a  rule, 
unsteady  and  fluctuating,  the  action  of  the  heart  and  small 
muscular  vessels  being  easily  disturbed  by  multitudinous 
causes,  mental  and  physical.  Then,  again,  it  may  be  %^w- 
eial,  extending  to  the  whole  nervous  system,  or  it  may  be 
strictly  localized,  involving  only  limited  parts  of  the  nervous 
system,  while  other  parts  do  not  participate  to  the  same 
extent  or  at  all.  Again,  it  may  be  hereditary  or  congenital, 
especially  the  former.  People  are  born  into  the  world 
daily,  to  begin,  live,  and  end  life,  neuresthenic,  or  at  least 
to  be  brought  early  into  that  state  ;  persons  who  have  from 
the  beginning  weak,  tricky  nervous  systems,  either  as  a 
whole,  or  in  some  of  its  parts.  On  the  other  hand, 
there  are  persons  to  be  met  with,  at  all  periods  in  life, 
and  of  both  sexes,  who  are  naturally  healthy,  as  the 
phrase  goes,  who  from  prolonged  over-exertion,  mental  or 
physical,  or  from  being  under  a  load  of  care  or  distress, 
or  from  prolonged  loss  of  sleep  or  loss  of  appetite,  or 
from  insufficient  food,  or  on  the  contrar}^  excessive  waste, 
as  in  hemorrhages  or  diarrhoeas,  or  on  account  of  some 
wasting  disease,  etc.,  and  suffer  a  loss  of  balance  in  their 
nutrition,  so  that  waste  for  a  long  time  predominates  over 
repair,  to  the  exhaustion  of  the  nervous  energies,  and  a 
great  gain  in  mobility,  or  "  shakiness  "  of  the  nervous  sys- 
tem, especially  the  nervous  centers. 

It  may  form  a  disease  (as  it  must  be  called)  by  itself, 
or  it  may  and  it  does  form  a  more  or  less  conspicuous 
element  in  a  great  variety  of  diseased  states,  one  which 
behooves  you  all  to  learn  and  detect  and  estimate.  It  is 
often  overlooked  or  under-estimated,  and  often  is  the 
obscure  and  all-important  element  in  cases  that  are  widely 
different  in  appearance.     It  is  the  undertone  in  the  picture 


CAUSES   CONTINIJED,    ADVERSITY,    ETC.  83 

in  a  vast  number  of  cases  of  "  heart  disease,"  "  brain  dis- 
ease," even  **  softening"  of  the  brain,  of  hysteria,  epilepsy, 
melancholia,  neuralgia,  paresis,  mental  weakness,  feeble 
circulation,  insomnia,  etc.  It  prevails  in  all  periods  of  life, 
and  in  both  sexes.  Instead  of  becoming  less  common,  it  is 
becoming  more  so,  as  time  passes,  and  as  people  as  a  whole 
become  more  sedentary  in  habits,  more  intellectual  in  activ- 
ities, more  engaged  by  occupation  or  by  culture,  so  as  to 
augment  the  sensibilities  at  the  expense  of  the  forces  or 
power  of  the  nervous  system. 

I  regard  the  refusal  to  take  proper  physical  rest,  when 
tired  from  labor,  as  one  of  the  most  important  and  power- 
ful in  inducing  a  love  for,  and  an  indulgence  in,  the  use  of 
ardent  spirits.  Men  work  till  they  get  so  tired  that  they 
cannot  wait  to  feel  sensibly  rested  by  processes  of  change 
going  on  in  their  systems  from  suspension  of  labor.  They 
either  want  to  work  more  hours  than  they  are  able  to  do  ; 
or  when  they  have  done  as  much  as  they  feel  themselves  at 
liberty  to  do,  they  are  so  tired  that  they  cannot  rest.  They 
get  rest,  therefore,  in  artificial  ways,  by  resorting  to  eating 
and  drinking.  Some  get  rested  by  drinking  tea,  others  by 
drinking  coffee,  otliers  by  chewing  and  smoking  tobacco  ; 
but  the  great  majority  of  tired  people  in  this  country — and 
the  larger  share  of  our  people  are  tired — drink  ardent  spirits 
in  some  or  oilier  of  its  forms  or  preparations.  They  fall 
back  on  stimulants  instead  of  the  intrinsic  vitalities  of  their 
bodies.  They  therefore  are  lifted  up  into  false  conditions. 
Accepting  these  as  true,  they  keep  on  working  till  they  be- 
come so  functionally  impaired  as  to  induce  positive  inability 
to  work  longer,  or  they  become  so  constitutionally  depreci- 
ated as  to  be  smitten  with  incurable  disease. 

The  hot  waves  wliich  follow  each  other  during  the  sum- 
mer months,  register  their  duration  and  intensity  in  the 
police  courts,  station-houses,  and  hospitals  of  all  large  cities 
by  the  sudden  increased  number  of  inebriates  who  come 
under    observation,     A    sudden  rise    of  the    thermometer 


84  DISEASES    OF   INEBRIETY. 

brings  more  drunken  men  to  the  station-house,  and  more 
acute  intoxication  is  noticed  on  the  streets.  Why  this  is  so 
is  not  clear.  Why  sliould  the  nerve  and  brain  debility  of 
inebriates  seem  more  easily  affected  by  extreme  heat  ?  Why 
should  alcohol  have  more  rapid  action,  causing  pronounced 
narcotic  effect?  Why  should  the  inebriate  use  spirits  more 
freely  at  such  times  ?  These  and  many  more  inquiries  await 
an  answer  from  the  scientists  and  future  investigation. 

One  view  of  the  subject  should  be  practically  recognized 
everywhere.  First,  the  great  danger  of  confining  intoxicated 
persons  arrested  on  the  street  in  hot  weather,  inclose,  badly 
ventilated  cells;  such  cases  are  in  great  danger  of  heatstroke. 
Narcotized  with  alcohol,  and  thrust  into  close,  stifling  air — 
all  the  favoring  conditions  are  present,  and  the  person  is 
found  dead  next  morning  in  the  cell,  or  in  a  state  of  deep 
stupor  from  which  he  dies  later.  The  real  cause  was  not 
the  intoxication,  but  the  heatstroke  from  the  close  air  of 
the  cell.  Close,  hot  cells  should  never  be  used  for  the  pur- 
pose of  confining  intoxicated  men  in  hot  w^eather. 

Second,  in  a  number  of  cases,  drinking-men  suffer  from 
partial  sunstroke  in  the  street  or  saloons,  and  are  taken  to 
station-houses,  as  simply  drunken  men.  They  are  placed 
in  cells,  receive  no  care,  and  die.  They  may  be  temperate, 
and,  feeling  bad,  take  a  glass  of  brandy  for  relief,  fall  into 
a  state  of  coma,  the  real  cause  being  the  sun  or  heat-rays  ; 
but  from  the  alcoholic  breath  they  are  judged  to  be  intox- 
icated and  taken  to  the  cell,  only  to  have  an  increase  of  their 
injury  and  die. 

Another  class  of  cases,  far  more  common  than  is  sup- 
posed, are  those  who,  after  a  partial  sunstroke,  take  a  single 
glass  of  spirits,  become  delirious,  and  are  called  **  crazy 
drunk."  They  are  roughly  taken  to  the  station,  and,  per- 
haps, hit  on  the  head,  with  no  other  idea  than  that  of  will- 
fulness, and  next  morning  are  dead,  or  are  taken  to  the 
hospital,  and  supposed  to  have  meningitis,  from  which  they 


CAUSES    CONTINUED,    ADVEKSITT,    ETC.  85 

die.  The  real  cause  was  the  policeman's  club,  and  hemorr- 
hage from  traumatism. 

Another  class  drink  ice-water,  or  soda  compounds,  to 
excess,  then,  to  relieve  the  distress  from  tiiese  drinks,  take 
brandy  or  whisky  and  become  delirious.  They  are  arrested, 
and  thrust  into  a  cell  like  the  others,  and  if  they  do  not 
have  a  heatstroke  suffer  from  injury  in  their  delirium  by 
striking  their  heads  against  the  walls.  Policemen  have  no 
other  standard  except  the  alcoholic  breath  for  determining 
the  state  of  the  person. 

An  instance  came  under  my  observation,  of  a  man, 
poorly  dressed,  who  was  overcome  by  heat  and  exhaustion, 
and  was  given  a  glass  of  whisky  by  a  kind-hearted  store- 
keeper. He  became  delirious,  was  taken  to  the  station, 
and  from  thence  to  the  hospital,  where  he  died  a  few 
days  later.  The  autopsy  revealed  a  fractured  skull  and  a 
ruptured  artery,  which  came  from  the  struggles  in  the 
arrest  or  self-inflicted  injury  in  the  cell. 

T/ii'rd,  jndges  who  administer  so-called  justice  to  these 
poor  victims,  often  assume  that  this  sudden  increase  of 
inebriates  demands  increased  severity  of  punishment  ;  and 
the  wrong  of  arresting  every  one  indiscriminately  and 
sending  them  to  station-houses  is  still  further  increased. 
Justice  is  outraged,  and  the  burdens  of  the  tax-payer 
increased,  and  the  danger  to  life  and  property  made  greater 
by  recruits  to  the  dangerous  classes — classes  diseased  and 
incapable  beyond  recovery,  yet  treated  as  law-abiding 
citizens  and  held  responsible. 

Tlie  medical  men  in  every  town  should  insist  that  all 
men  arrested  during  hot  periods  for  supposed  intoxica- 
tion should  come  under  medical  care,  and  be  examined 
carefully  before  they  are  thrust  into  cells.  The  community 
sliould  be  tauglit  that  the  increased  number  of  acute  inebri- 
ates in  hot  weather  points  to  ranges  of  physical  causes  that 
require  study,  and  cannot  be  treated  by  policemen  or  police 
judges.      Hot    cells,   in    the     ordinary    station-houses,  are 


86  DISEASES    OF   INEBRIETY. 

sources  of  danger  that  should  be  avoided.  The  delirious 
or  comatose  inebriate  who  is  placed  in  such  cells  over  night, 
is  practically  murdered.  The  chances  of  escape  from  heat- 
stroke and  traumatism  are  far  less  than  the  hope  of  recov- 
er^^  The  skill  to  correctly  determine  the  condiiion  of 
these  acute  inebriates  who  are  arrested  in  hot  weathei",  is 
far  greater  than  in  ordinary  insanity,  and  should  not  be 
trusted  to  policemen  and  non-experts.  Here  is  a  field  for 
tiie  ambitious  pliysician  who  would  discover  new  ranges  of 
physical  causes,  and  point  out  methods  of  prevention  of 
tlie  greatest  practical  importance. 

Those  who  use  alcohol  in  any  form,  either  moderately 
or  in  excess,  suffer  more  frequently  from  sunstroke  and 
heat  apoplexies.  The  fatality  of  these  cases  are  greater 
than  in  those  who  are  abstainers.  The  brain  disturbances 
following  are  more  serious  and  prolonged,  and  in  many 
cases  acute  manias,  various  palsies,  and  dipsomaniac 
impulses  are  very  prominent. 

Many  of  these  cases  occur  in  persons  who  are  not 
thought  to  be  other  than  moderate  drinkers,  particularly 
as  they  are  seldom  seen  intoxicated,  and,  although  at  the 
time  of  the  sunstroke  may  have  the  odor  of  alcohol  about 
them,  yet  are  not  considered  to  be  injured  by  spirits  in  any 
particular  way.  Tiiese  cases  suffer  from  sunstroke  in  two 
ways  :  either  from  the  direct  rays  of  the  sun,  or  from  the 
heat  of  close  rooms  or  areas.  In  the  latter  case  it  occurs 
most  frequently  after  sunset  and  before  midnight.  Very 
serious  mistakes  are  frequently  made  in  the  diagnosis  by 
physicians.  A  man  will  be  found  in  the  street  in  a  state  of 
coma,  with  an  alcoholic  breath,  which,  to  a  superficial 
observer,  points  to  spirits  as  a  cause.  The  real  cause,  sun- 
stroke, is  not  recognized,  and  death  follows  in  a  cell  at  the 
station-house,  or  in  some  other  place,  and  nothing  has  been 
done  to  avert  this  event.  In  any  case  of  coma  found  in  the 
street  in  hot  weather,  the  diagnosis  of  apoplexy  from  heat 
should  be  considered,  irrespective  of  all  alcoholic  odors  in 


CAUSES    CONTIlSrUED,    ADVERSITY,    ETC.  87 

the  breath.  A  moderate  and  only  an  occasional  user  of 
spirits,  feeling  bad,  took  a  glass  of  brandy,  and  soon  after 
suffered  from  sunstroke  and  was  taken  to  the  station-house, 
where  he  had  been  ordered  by  a  pliysician  who  made  a  diag- 
nosis on  the  odor  of  his  breath  alone.  A  clergyman  who 
drank  only  wine  at  meals,  and  was'  a  red-faced  man,  was 
struck  down  by  the  sun  soon  after  drinking  some  wine,  and 
was  taken  to  the  station  as  a  drunken  man,  the  diagnosis 
being  made  on  the  same  grounds.  The  physician  should 
not  forget  tliat  the  odor  of  spirits,  with  a  tendency  to  apo- 
plexy, excited  by  sunstroke  or  any  other  cause,  and  the 
circumstance  of  being  found  insensible  in  tiie  hot  sun,  is 
sufficient  to  warrant  a  diagnosis  of  sunstroke,  rather  than 
that  of  coma  from  alcohol. 

In  the  second  class,  more  difficulty  follows.  Thus,  a 
man  who  has  drank  in  moderation,  or  not  at  all,  will  be 
stricken  down  in  a  close  room,  and  if  the  odor  of  alcohol  is 
present  he  is  supposed  to  be  intoxicated.  Cases  of  this 
kind  are  frequent  in  bar-rooms,  and  close,  crowded  tene- 
ment-houses in  hot  nights.  The  real  diagnosis,  heat 
apoplexy,  is  often  overlooked.  A  man  comes  home  from  a 
hard  day's  work,  takes  a  glass  of  spirits,  and  goes  to  some 
close  room  where  the  air  does  not  circulate  and  radiation 
is  imperfect,  and  soon  after  has  an  attack  of  heat  apoplexy  ; 
or,  he  may  go  to  some  close  bar-room,  and  late  in  the 
evening  be  stricken  down. 

These  cases  occur  most  frequently  in  large  cities,  and 
close,  narrow  streets,  but  will  be  found  in  all  sections  of  the 
country  where  the  conditions  of  heat  and  surroundings  are 
favorable.  The  advice  given  in  India  to  the  English  resi- 
dents and  troops  is  very  sensible  and  correct.  First,  to 
abstain  from  all  alcoholic  drinks  during  the  hot  season  ; 
and,  second,  to  drink  large  quantities  of  water,  especially 
in  hot  days.  With  this  are  many  directions  about  the  care 
of    the    body,    namely  :    to    avoid     over-work,   pressure   of 


88  DISEASES    OF   INEBRIETY. 

clothes,  bad  food,  and  so  on.  Partial  sunstrokes  are  more 
common  where  the  person  has  a  faint,  attended  with  dizzi- 
ness, momentary  loss  of  consciousness,  followed  by  severe 
headache  and  great  prostration.  These. attacks  have  a  very 
serious  influence  on  moderate  or  excessive  drinkers.  Often 
it  is  the  beginning  of  profound  degenerations,  which  go  on 
rapidly  to  death.  Heat  apoplexies  are  very  intimately 
associated  as  causes  of  inebriety,  and  when  occurring  in 
inebriates,  lead  to  the  gravest  results. 

The  use  of  spirits  in  any  form  undoubtedly  favors  and 
predisposes  to  sunstroke  ;  and  whatever  the  explanation 
may  be,  it  is  certain  that  he  who  uses  alcohol  has  less  vigor 
and  resisting  power  to  high  degrees  of  heat. 

In  the  comparison  of  the  histories  of  many  cases  of 
inebriety,  certain  ranges  of  fact  appear  in  a  regular  order. 
Continuous  chains  of  cause  and  effect  run  through  all  the 
events.  What  appears  to  be  the  free  will  of  the  victim  is 
but  a  narrow  channel  along  which  he  is  forced  by  condi- 
tions which  he  cannot  escape.  Appeals  to  his  feelings  and 
reason  are  useless,  for  these  faculties  are  unable  to  direct  or 
control  the  progress  of  disease.  Often  the  victim  is  uncon- 
scious that  he  has  lost  his  power  of  control,  unconscious  of 
the  march  of  events  ;  the  steady  disintegration  of  brain 
vigor  and  health,  and  never  realizes  it.  Delusions  of  health 
and  self-control  become  fixed  as  the  disease  goes  on.  The 
range  of  his  mental  powers  steadily  narrow  and  approach 
the  animal  in  comparison,  and  are  finally  lost  in  a  general 
dissolution. 

The  agents  exciting  the  emotions,  and  exhausting  tlie 
nerve  forces,  and  so  causing  inebriety,  are  everywhere 
present  in  the  tremendous  activities  of  our  American 
civilization. 

The  atmosphere  is  full  of  psychological  germs,  calcula- 
ted to  infect  the  nervous  system  and  produce  disease. 
"  Hopes  and  fears,  appealing  to  the  deepest  motives  of  our 
nature  ;  political  excitement,  producing  tumults  of  passion 


CAUSES    CONTINTTED,    ADVEKSITY,    ETC.  89 

and  bitter  feeling  ;  commercial  waves  of  good  and  bad 
fortune,  causing  alternately  intense  joy  and  as  intense  disr 
appointment  and  chagrin  ;"  these  are  some  of  tlie  dangers 
breaking  up  the  healthy  mental  equilibrium  and  increasing 
the  perils  of  every  life.  It  is  in  this  atmosphere  that 
inebriety  begins  and  goes  to  full  development,  standing  out 
in  lurid  relief  with  our  boasted  civilization. 


CHAPTER  X. 

INEBRIETY    IN    AMERICA    AND   ITS    PECULIARITIES,    ETC. 

Inebriety  in  America  is  more  impulsive  and  precipitate 
than  in  other  countries,  the  period  of  moderate  drinking  is 
less  marked,  and  the  average  life  of  the  inebriate  is  shorter. 
Among  the  many  reasons  for  this  are  the  tremendous 
activity  and  competition  in  the  ordinary  vi^ork  of  life,  the 
intensity  of  living,  the  constant  excitement  and  changes, 
filling  every  moment  of  time,  calling  out  every  energy,  put- 
ting them  in  a  constant  strain,  followed  by  want  of  rest, 
neglect  of  the  healthy  functions  of  the  body,  etc.,  etc.  Add 
to  this  the  constant  practice  of  using  the  stron'gest  alcohols 
at  all  times  and  occasions,  and  it  will  be  seen  that  the 
average  American  must  of  necessity  possess  less  resting 
power,  and  will  fall  a  victim  more  readily  to  the  action  of 
alcohol. 

The  effects  of  these  influences  are  marked  psychologic^ 
ally  in  the  character  of  the  inebriety  seen  in  America. 
When  under  the  influence  of  alcohol  the  average  American 
is  full  of  delusions  of  speculation  for  wealtli,  power,  and 
political  achievement  ;  his  ideas  flow  in  a  channel  of  great 
events,  and  great  schemes  for  the  welfare  of  the  nation  and 
ilie  race  ;  he  is  rarely  a  wife-beater  or  avenger  of  personal 
worngs,  but  may  be  prominent  in  a  mob  to  destroy  some 
great  evil,  or  foremost  to  break  up  some  old  order  of  events 
which  are  supposed  to  be  blocking  the  wheels  of  progress. 
The  inebriate  American  will  always  be  found  in  the  van  of 
every  new  project    in    politics,  social  science,  religion,  and 

90 


INEBEIETY    IN   AMERICA.  91 

business,  and,  like  Colonel  Sellers,  is  buoyed  up  with  the 
stimulating  hope  of  "  There's  millions  in  it."  The  records 
of  courts  rarely  exhibit  brutal  crime  among  inebriates  who 
are  Americans,  but  great  schemes  of  companies,  frauds, 
and  stupendous  swindles,  for  money  or  notoriety,  etc., 
etc.,  are  common  among  this  class.  The  increased  con- 
sumption of  all  forms  of  alcoholic  drinks,  beyond  the 
average  gain  of  population,  give  indications  of  the  in- 
crease of  inebriety.  This  is  confirmed  by  the  court 
records  of  drunkenness  in  all  the  large  cities  and  towns, 
and  also  from  comparative  evidence  of  the  mortuary  sta- 
tistics which  point  to  a  rapid  increase  of  those  diseases 
which  are  most  common  in  inebriates  :  namely,  insanit}', 
paralysis  and  acute  affections  of  the  heart,  kidneys  and 
lungs.  It  may  be  said,  beyond  all  doubt,  that  inebriety  in 
America  terminates  most  frequently  in  acute  organic 
affections  of  the  body.  Another  fact  of  great  interest  is 
apparent  to  the  psychological  student,  namely,  that  ine- 
briety in  America  moves  in  waves  and  currents, with  a  decided 
epidemic  and  endemic  influence.  This  can  be  traced  to 
the  rapid  increase  of  drunkenness  in  towns  and  cities,  and 
after  a  time  a  reaction  sets  in,  and  a  marked  decline  follows  ; 
the  latter  is  seen  following  the  temperance  agitation  and 
revivals.  In  some  cases  this  is  traced  to  special  causes, 
such  as  financial  depression,  great  social  changes,  etc.  ;  at 
such  times  moderate  drinkers  become  pronounced  inebriates 
and  weak,  nervous  organizations  fall  into  inebriety.  This 
increases  up  to  a  certain  point,  then  from  some  unknown 
psychical  force  declines,  and  a  revival  of  temperance  efforts 
follows,  with  a  decline  of  inebriety  to  a  minimum.  These 
waves  and  inebriate  storms  that  sweep  over  large  circles  of 
country  are  always  followed  by  intense  revivals  of  temper- 
ance interest,  and  are  fields  of  the  most  fascinating  psycho- 
logical interest  yet  to  be  studied. 

Alcholic  inebriety  among  American  women  is  undoubt- 
edly   becoming    less    every    year.      Although    it    is    more 


92  DISEASES    OF   INEBRIETY. 

covered  up  tlian  in  oilier  countries,  yet  its  presence  is 
apparent  in  the  demand  for  narcotics,  and  the  sale  of  beer 
and  wine  by  grocers,  also  in  the  divisions  of  saloons  into 
general  and  family  entrances,  with  separate  rooms  for  each. 
Among  the  better  classes  of  women  wine  and  spirits  are  less 
openly  used,  and  social  drinking  more  rare.  The  same  is 
true  of  all  classes,  except  those  of  foreign  birth,  who  still 
cling  to  the  old  custom  of  public  drinking.  The  same  gen- 
eral causes  govern  women  that  are  noticed  among  men,  only 
varying  in  degree  ;  hence,  while  women  do  not  use  alcoholic 
spirits  as  men  do,  undoubtedly  they  consume  all  forms  of 
narcotics  in  excess  of  other  classes.  Their  peculiar  sensitive 
organization  demands  narcotics  as  a  relief  from  the  strain 
and  exhaustion  to  vyhich  they  are  constantly  subjected,  and 
this  is  a  source  of  great  peril  to  the  future  of  the  American 
race. 

In  this  brief  outline  of  the  nature  and  character  of 
inebriety,  it  may  be  said  that  American  inebriety  is  more 
often  a  pronounced  form  of  brain  and  nerve  degeneration, 
and  that  it  comes  from  well  marked  physical  conditions, 
largely  controlled  by  social  and  psychical  states  peculiar  to 
America.  Its  symptomology  more  nearly  resembles  that  of 
insanity  and  general  paralysis  ;  its  course  is  in  waves  and 
currents  ;  its  progress  is  shorter  ;  and  among  women  the 
use  of  narcotics  is  more  prevalent  than  of  other  forms  of 
alcohol. 

At  the  recent  international  congress,  held  in  London 
under  the  auspices  of  the  Society  for  the  Study  of  Inebri- 
ety, brief  reference  was  made  to  certain  factors  which  con- 
tribute to  make  the  study  of  inebriety  in  America  specially 
serious  and  urgent. 

Although  there  are  abiding  factors  the  world  over,  in 
America  we  have  elements  to  study  which  are  peculiar  and 
unique.  Bs'  America  is  meant  the  American  Republic,  the 
States  and  Territories  bounded  by  the  seas,  the  lakes  and 
the  gulf.     Here  sixty  millions  of  people  are  placed  under 


mEBRIETT   IN   AMERICA.  93 

those  physical,  ps3xhic,  political  and  social  conditions  which 
combine  to  make  life  more  vividly  intense  atid  exacting  than 
anywhere  else  on  tliis  planet,  and  therefore  are  more  sus- 
ceptible to  the  malady  of  inebriism. 

This  region  luis  been  called  "  the  intemperate  belt." 
"  Inebriety  may  be  said  to  have  been  born  in  America  and 
has  developed  sooner  and  far  more  rapidly  than  elsewhere  ; 
and  like  otiier  nerve  maladies  is  especially  frequent  here. 
It  is  for  this  reason,  mainly,  that  asylums  for  inebriates  were 
first  organized  here."  Here  also  the  total  abstinence  soci- 
eties of  modern  days  began.  Why  ?  because  of  the  abnor- 
mal nerve  sensibility  which  the  feverish  rush  of  life  here  has 
developed,  a  physiological  condition,  that  will  not  tolerate 
stimulants. 

Dr.  Beard  says  that  it  is  a  greater  sight  than  Niagara, 
which  is  presented  to  a  European  coming  to  this  land,  to 
behold  an  immense  body  of  intelligent  citizens,  voluntaril}'- 
and  habitually  abstaining  from  alcoholic  beverages.  "  There 
is  perhaps  no  single  fact  in  sociology  more  instructive  and 
far  reaching  than  this  ;  and  this  is  but  a  fraction  of  the 
general  and  sweeping  fact  that  the  heightened  sensitiveness 
of  Americans  forces  them  to  abstain  entirely,  or  to  use  in 
incredible  and  amusing  moderation,  not  only  the  stronger 
alcoholic  liquors,  but  the  milder  wines,  ales,  and  beers,  and 
even  tea  and  coffee.  Half  my  nervous  patients  give  up 
coffee  before  I  see  them,  and  very  many  abandon  tea.  Less 
than  a  century  ago,  a  man  who  could  not  carry  many  bottles 
of  wine,  was  thought  effeminate.  Fifty  years  ago  opium 
produced  sleep,  now  the  same  dose  keeps  us  awake,  like 
coffee  and  tea.  Susceptibility  to  this  drug  is  revolutionized." 
Dr.  Beard  makes  the  ability  to  bear  stimulants  a  measure 
of  nerves,  and  asserts  that  the  English  are  of  "more  bottle- 
power  than  the  Americans  ;"  that  it  is  worth  an  ocean-voy- 
age to  see  how  they  can  drink.  A  steamer  seat-mate  poured 
down,  almost  at  a  swallow,  a  half  tumblerful  of  whiskey 
with  some  water  added.     He  was  a  prominent  minister  in 


94:  DISEASES    OF    INEBRIETY. 

the  Established  Church,  advanced  in  years,  yet  robust.  He 
replied  to  the  query,  "  How  can  you  stand  tiiat  ?"  that  he  had 
been  a  drinker  all  his  life  and   felt  no  harm. 

Tlie  same  relative  sensitiveness  is  shown  in  regard  to 
opium,  tobacco,  and  other  narcotic  poisons.  The  stolid 
Turk  begins  to  smoke  in  early  childhood,  when  seven  or 
eight  ;  everybody  smokes,  men,  women,  and  little  ones,  yet 
the  chief  oculist  in  Constantinople  says  that  cases  of  amau- 
rosis are  very  few.  A  surgeon  whom  I  have  known.  Dr. 
Sewny,  of  Aintab,  after  3''ears  of  extensive  practice  in  Asia 
Minor,  has  yet  to  see  the  first  case  of  amaurosis  or  ambly- 
opia due  solely  to  tobacco.  But  Americans  cannot  imitate 
Turk,  Hollander,  and  Chinese.  Heart  and  brain,  eyes, 
teeth,  muscle,  and  nerve  are  ruined  by  these  vices,  yet  the 
frightful  fact  remains  that  laterally  the  importation  of 
opium  has  increased  500  per  cent.!  The  "tobacco  heart" 
and  other  fatal  effects  of  cigarette  smoking  are  attracting 
the  attention  of  legislators  as  well  as  physicians,  and  the 
giving  or  selling  this  diminutive  demon  to  youth  is  made 
in  some  places  a  punishable  offense. 

Physical,  psychic,  political,  and  social  conditions  com- 
bine in  the  evolution  of  this  phenomenal  susceptibility. 
Nowhere,  for  instance,  are  such  extremes  in  thermal  changes. 
I  have  seen  in  New  England  a  range  of  125",  from  25° 
below  to  100^  above,  in  the  shade.  The  year's  record  at 
Minnesota  has  read  from  39°  below  to  99'^  above,  a  range 
of  138".  Even  within  twenty-four  hours,  and  in  balmy 
regions  like  Florida,  the  glass  has  shown  a  leap  from  torrid 
heat  to  frosty  chill. 

No  wonder  then  the  greatest  fear  of  some  is  the  atmos- 
phere !  They  dreadeS  to  go  out  to  face  Arctic  rigor  or 
tropic  fire,  and  so  get  in  the  way  of  staying  indoors  even 
in  exquisite  weather  of  June  and  October.  They  make 
rooms  small,  put  on  double  windows,  with  list  on  the  doors, 
and  build  a  roaring  furnace  fire  in  the  cellar,  adding 
another  of  bright  anthracite  in  the  grate.     The  difference 


INEBRIETY   IN   AMERICA.  95 

befween  tliis  liot,  dry,  baked  air  within,  and  the  wintry  air 
without,  is  sometimes  80°.  It  is  estimated  that  the  differ- 
ence of  temperature  inside  and  outside  an  English  home 
averages  20",  and  tliat  within  and  without  an  American 
dwelling  is  60°.  The  relation  of  this  to  the  nervousness  of 
the  people  is  apparent. 

The  uniform  brightness  of  American  skies  favors  evapo- 
ration. The  Yankee  is  not  plump  and  ruddy  like  his  moist, 
solid  British  brother,  but  lean,  angular,  wiry,  with  a  dry, 
electrical  skin.  He  lights  the  gas  with  his  fingers,  and  fore- 
tells, with  certainly,  the  coming  storm  by  his  neuralgic 
bones.  Hourl}'^  observations  were  conducted  for  five  years 
with  Captain  Catlin,  U.  S.  A.,  a  sufferer  from  traumatic 
neuralgia  in  care  of  Dr.  Mitchell.  The  relation  of  these 
prognostic  pains  to  barometric  depression  and  the  earth's 
magnetism  was  certified  beyond  doubt,  and  was  reported 
to  the  National  Academy  of  Science,  April,  1879.  Even 
animals  in  the  Sacramento  valley  and  on  the  Pacific  coast 
are  unwontedly  irritable  while  the  north  desert  winds  are 
blowing,  and  electricity  seeking  equilibrium,  going  to  and 
from  the  earth.  Fruits,  foliage,  and  grass,  towards  the 
wind,  shrivel.  Jets  of  lightning  appear  on  the  rocks  and 
sometimes  on  one's  walking  stick. 

"^wl  psycJiic  and  social  factors  cannot  be  ignored.  Some- 
one has  said  that  insanity  is  the  price  we  pay  for  civilization. 
Barbarians  are  not  nervous.  They  may  say  with  the  Duch- 
ess of  Marlborough  that  they  were  born  before  nerves  were 
invented.  They  take  no  thought  of  the  morrow.  Market 
returns  and  stock  quotations  are  unknown  ;  telephones  and 
telegraphs  ;  daily  newspapers,  with  all  their  crowded  col- 
umns of  horror  and  crimes,  are  not  thrust  upon  them  ;  and 
the  shriek  of  the  steam  engine  does  not  disturb  their  mid- 
day or  their  midnight  sleep.  Once  a  day  they  may  look  at 
the  sun,  but  they  never  carry  watches.  This  bad  habit  of 
carrying  watches  is  rebuked  by  a  distinguished  alienist, 
who  says  that  a  look  at  one's  watch,  when  an   appointment 


96  DISEASES    OF   INEBRIETY. 

is  near,  sensibly  accelerates  the  heart's  action  and  is  correl- 
ated to  a  definite  loss  of  nervous  energy.  Every  advance  of 
refinement  brings  conflict  and  conquest  that  are  to  be  paid 
for  in  blood  and  nerve  and  life. 

Now,  it  is  true,  that  watches  are  occasional!}'  seen  in 
England.  Sun-dials  are  not  in  common  use  in  Germany 
and  Switzerland.  But  the  "American  Watch  "  is  an  institu- 
tion. Not  the  Elgin,  the  Waterbury,  or  any  particular 
watch,  but  the  worry  and  haste  and  incessant  strain  to 
accomplish  much  in  a  little  time — all  this  symbolized  in  the 
pocket  time-piece,  is  peculiarly  American.  It  was  an  Amer- 
ican who,  at  Buffalo,  I  think,  wanted  to  wire  on  to  Washing- 
ton. When  told  it  would  take  ten  minutes,  he  turned  away 
and  said,  "I  can't  wait."  He  now  uses  the  Edison  telephone, 
and  talks  mouth  to  mouth  with  his  friend.  Dr.  Talmage 
says,  "We  were  born  in  a  hurry,  live  in  a  hurry,  die  in  a 
hurry,  and  are  driven  to  Greenwood  on  a  tro.t  !"  The  little 
child,  instead  of  quietly  saying  to  its  playmate  "Come,"  ner- 
vously shouts,  "Hurry  up  !"  You  cannot  approach  the 
door  of  a  street  car,  or  railway  carriage,  but  what  you  hear 
the  same  fidgety  cry,  "  Step  lively  !" 

Said  a  New  Yorker  to  me,  "  I  am  growing  old  five  years 
every  year."  Can  such  physical  bankrupts,  whose  brains 
are  on  the  brink  of  collapse,  bear  the  added  excitement  of 
drink?  The  gifted  Bayard  Taylor  was  but  one  of  thousands 
who  burned  a  noble  brain  to  ashes  in  a  too  eager  race  of 
life.  Reviewing  sixteen  months  he  notes  the  erection  of  a 
dwelling-house,  with  all  its  multitudinous  cares,  the  issuing 
of  two  volumes  of  his  writings,  the  preparation  of  forty-eight 
articles  for  periodicals,  the  delivery  of  250  lectures,  one 
every  other  day,  and  30,000  miles  travel.  The  same  story 
might  be  told  of  other  brain-workers  who  never  accepted 
the  "gospel  of  rest." 

The  emulous  rivalries  of  busitiess  life  and  the  speculative 
character  of  its  venture  cannot  be  paralleled  elsewhere.  The 
incessant    strain  they    impose  increases  mental  instability. 


INEBRIETY    IN    AMERICA.  97 

Bulls  and  bears,  pools,  corners,  margins,  syndicates,  and 
other"  words  that  are  dark,  and  tricks  that  are  vain,"  rep- 
resent the  omnivorous  passion  for  gambling.  Millions  may 
be  made  or  lost  in  a  day.  No  one  is  surprised  if  a  Wall 
Street  panic  is  followed  by  suicides. 

Legitimate  business  may,  by  its  methods,  exert  a  per- 
nicious influence  on  the  nervous  system  in  still  oilier  ways, 
as  for  example,  in  tlie  depressing  influence  from  specializa- 
tion of  nerve  function,  as  indicated  by  D!\  Jevy'ell,  where 
one  keeps  doing  one  petty  thing  monotonously  year  after 
year  and  so  sterilizes  mind  and  muscle  in  every  other 
direction. 

Turning  to  educational  systems  in  America,  we  see  how 
unphysiological  they  are,  and  calculated  to  exhaust  the  ner- 
vous energy  of  youth,  many  of  whom  have  inherited  a  morbid 
neurotic  diathesis.  Of  twenty-seven  cases  of  chorea  reported 
by  Dr.  Hamimond  of  Bellevue  Hospital,  eight  were  "  induced 
by  intense  study  at  school."  Dr.  Treichler's  investigations 
as  to  "  Habitual  Headache  in  Children,"  cover  a  wide  field 
and  show  that  continental  communities  suffer  from  similar 
neglect  of  natural  laws.      Here  it  is  more  notorious. 

Not  to  dwell  on  these  points,  we  may  say  that  the 
stimulus  of  liberty  is  a  productive  cause  of  neurasthenia  in 
America.  It  is  stated  that  insanity  has  increased  in  Italy 
since  there  has  been  civil  and  religious  liberty  guaranteed. 
Kpost  hoc  is  not  always  Sl propter  hoc.  But  it  is  obvious  that 
the  sense  of  responsibility  which  citizenship  brings  ;  the 
ambitions  awakened  by  the  prospect  of  office,  position, 
power,  and  influence  ;  the  friction  and  disquiet,  bickerings 
and  wranglings,  disappointment  and  chagrin  that  attend  the 
struggles  and  agitations  of  political  life,  do  exhaust  men, 
and  more  in  a  land  where  opportunities  for  advancement 
are  abundant  as  in  America.  While  writing  these  words, 
news  is  received  of  the  sudden  death  of  a  prominent  New 
York  politician,  comparatively  young,  directly  traceable  to 
disappointment  in  carrying  out  a  scheme  on  which  his  lieart 


98  DISEASES   OF   INEBRIETY. 

was  set.  Chagrin  acted  like  a  virulent  poison  on  a  system 
already  unstrung  by  the  severe  political  struggle  in  which 
he  was  defeated. 

Multitudes  contract  the  full  malady  of  inebriism  under 
the  continued  pressure  of  these  political  campaigns.  The 
patient  of  a  friend  of  mine  had,  for  two  years,  been  kept  in 
working  order.  He  was  living,  however,  on  a  small  reserve 
of  nerve  force.  A  few  days  before  election,  he  was  drawn 
into  a  five  minutes  eager  discussion,  and  became  entirely 
prostrated,  more  exhausted  tlian  by  months  of  steady  work. 

Other  nations  have  their  measure  of  liberty  and  aspira- 
tions for  social  and  political  eminence  to  gratify.  But 
nowhere  have  men  the  exliilarating  possibilities  of  position, 
wealth,  and  influence,  that  this  republican  community  offers. 
The  history  of  the  last  half  century,  as  related  to  this  fact, 
reads  like  a  romance.  But  liberty,  like  beauty,  is  a  perilous 
possession,  and  it  lias  been  truly  said  "  the  experiment 
attempted  on  this  continent  of  making  every  man,  every 
child,  every  woman  an  expert  in  politics  and  theology  is  one 
of  the  costliest  of  experiments  with  living  human  beings, 
and  has  been  drawing  on  our  surplus  energies  for  one  hun- 
dred years." 

Final Iv,  American  life  is  cosjnopolitati.  A  curious  observer 
noted  nine  nationalities  in  a  single  street  car  in  New  York, 
one  day.  I  repeated  the  fact  to  a  few  of  my  students  who 
were  riding  with  me  througli  those  same  streets.  Looking 
over  the  ten  or  dozen  passengers  on  board,  one  of  them  at 
once  replied,  "  Well,  here  are  five  nationalities  represented 
here." 

In  one  aspect,  these  importations,  particularly  English, 
German,  and  Scandinavian,  are  compensative  and  antidotal. 
We  may  hope,  with  the  author  before  quoted,  that  "  the 
typical  American  of  the  highest  type  will,  in  the  near  future, 
be  a  union  of  the  coarse  and  .fine  organizations  ;  the  solidity 
of  the  German,  the  fire  of  the  Saxon,  the  delicacy  of  the 
American,  flowing  together  as  one;  sensitive,  impressible, 


INEBRIETY    IN   AMERICA.  99 

readily  affected  through  all  the  avenues  of  influence,  but 
trained  and  held  by  a  will  of  steel  ;  original,  idiosyncratic  ; 
with  more  wiiiness  than  excess  of  strength,  and  achieving 
his  purpose  not  so  much  through  the  amount  of  his  force 
as  in  the  wisdom  and  economy  of  its  use." 

This  hope  may  be  realized  in  the  future  and  in  the 
highest  type  of  American  manhood.  It  is  a  bright,  optim- 
istic view  of  things,  but  we  have  to  do  with  the  present 
and  the  evils  of  society  as  they  exist.  We  have  to  face  the 
fact  that  our  civic  life  is  growing  at  the  expense  of  the 
rural  ;  that  our  cities  are  massing  people  by  the  hundreds 
of  thousands,  among  whom,  on  the  grounds  of  contiguity, 
association,  and  psychic  sympathy,  evil  influences  become 
more  potent  to  undermine  the  welfare  of  society  ;  that 
we  have  to  encounter  in  America  the  drink  traffic  in  its 
belligerant  aspects,  as  nowhere  else,  not  only  politically  and 
financially  organized  most  thoroughly,  but  ready  it  would 
seem  to  use  fraud,  violence,  or  assassination  if  other  means 
fail,  and  that  we  have  anarchism  stirring  up  discontent  and 
firing  the  passions  of  the  desperate  classes,  who  understand 
liberty  to  mean  license,  equality  to  be  the  abolition  of  all 
the  diversities  of  position  and  property  which  intelligence, 
temperance,  and  industry  have  made,  and  will  make,  to 
the  end  of  time. 

We  have  had  a  practically  unrestricted  importation  of 
the  refuse  population  of  Europe.  Of  every  250  emigrants 
one  is  insane,  while  but  one  of  662  natives  is  insane.  Add 
to  all  these  facts  the  conditions  of  American  life  already 
enumerated  as  related  to  the  development  of  neuroses,  par- 
ticularly inebriety,  and  we  have  material  which  makes  the 
study,  as  was  stated  at  the  start,  serious  and  urgent. 


CHAPTER   XI. 

PREVALENCE   OF  INEBRIETY    AND   ITS   MORTALITY,    ETC. 

Notwithstanding  all  the  advances  of  civilization  and 
intelligence,  and  the  increasing  temperance  agitation  and 
effort,  the  drink  evil,  or  inebriety,  is  one  of  the  most  threat- 
ening, ominous  perils  to  all  social  progress  and  development 
of  to-day. 

Some  idea  of  its  extent  may  be  obtained  from  the  fol- 
lowing satistics.  In  1891  over  five  hundred  tliousand  per- 
sons were  arrested  in  this  country  charged  with  being 
drunk  and  disorderly,  crazed  from  the  effects  of  alcohol. 
Nearly  twenty  per  cent,  had  committed  crime  of  petty 
character  while  under  influence  of  spirits. 

These  facts  furnish  some  approximate  estimate  of  the 
extent  of  inebriety  in  this  country.  It  is  reasonable  to  infer 
that  if  this  number  of  inebriates  have  come  under  police 
surveillance  in  one  year,  at  least  a  third  more  using 
alcohol  to  excess,  have  escaped  legal  notice. 

The  statement  that  there  are  fully  a  million  persons  in 
this  country  who  are,  continuously  or  at  intervals,  using 
alcohol  and  opium  to  excess  and  poisoning  tlieniselves,  is 
not  an  extravagant  or  improbable  one. 

Of  course  the  mortality  from  this,  both  directly  and 
indirectly,  is  excessive,  and  the  oft  repeated  assertion  of 
sixty  and  a  hundred  thousand  deaths  a  year  from  alcohol  is, 
after  all,  only  a  minimum  statement. 

The  physical  and  mental  degeneration,  the  unsanitary 
conditions  of  living  and  surroundings,  predisposing  to  pau- 
perism and  exhaustion,  all  strongly  favor  disease,  accident 
and  early  death.  Dr.  Kerr,  of  London,  after  a  very  exhaust- 
100 


PEEVALENCE   OF    INEBRIETY.  101 

ive  Study  of  the  mortality  reports  of  the  United  Kingdom, 
concluded  that  the  annual  mortality  from  inebriety  could 
not  be  less  than  one  hundred  and  twenty  thousand. 

This  statement  was  confirmed  by  Mr.  Wakel}'',  a  well 
known  coroner,  who  found  in  fifteen  hundred  inquests  held 
in  one  year,  nine  hundred  of  them  were  from  inebriety. 
The  conclusions  of  the  late  Mr.  Neilson,  tlie  eminent  actuary, 
are  equally  striking.  He  found  that  while  ten  temperate 
persons  from  15  to  20  years  of  age  die,  eighteen  inebriates  of 
the  same  age  die.  Between  21  and  23  years  (inclusively) 
51  of  the  intemperate  of  inebriates  die  for  every  10  of  the 
temperate.  Between  31  and  40  about  40  die.  In  the  first 
group  the  fatality  is  raised  80  percent.,  in  the  second  over 
500  per  cent.,  and  in  the  third  400  per  cent.  Mr.  Neilson 
calculated  the  cliances  of  life  as  follows  :  A  temperate 
adults  chances  of  life  is  at  20  over  44  years,  an  intem- 
perate 15/^  years  ;  at  30  a  temperate  36/^,  an  inebriate  13.8 
years  ;  at  40  a  temperate's  28.8  years  and  an  inebriates  11.6. 

In  the  mortality  of  Great  Britain  only  between  1400  and 
1500  deaths  are  noted  as  arising  from  alcohol  annually. 
But  it  is  well  known  that  these  figures  are  no  criterion  of 
the  actual  number  of  deaths  from  inebriety.  The  present 
system  of  death  certificates  makes  it  easy  to  evade  the  real 
cause  of  death,  and  put  down  some  intercurrent  affection 
or  condition  that  occurs  just  before  death  takes  place. 
This  is  done  to  save  the  feelings  of  friends  and  relatives, 
and  cover  up  some  state  which  would  only  add  new  pangs 
of  sorrow  by  exposure. 

A  new  system  of  registration  is  demanded  to  ascertain 
accurately  many  of  such  mortality  facts. 

Tiie  Harvian  Society  of  London  have  studied  this  topic 
and  reached  similar  conclusions,  sustaining  Dr.  Kerr's  esti- 
mate of  one  hundred  and  twenty  thousand  deaths  yearly  in 
the  United  Kingdom  from  inebriety.  In  this  country  the 
late  Dr.  Parker  showed  from  some  comparative  facts  that 
inebriates  had  an  average  of  ten    years,  after  the  full  devel- 


102  DISEASES   OF    INEBRIETY. 

opment  of  the  drink  curse.  Dr.  Harris  indicated  that  twenty 
per  cent,  of  all  deaths  in  large  cities  were  due  to  inebriety. 

All  the  life  insurance  companies  find  the  mortality  which 
dates  from  heart  and  kidney  disease  associated  with  the 
use  of  alcoholics,  and  many  of  them  refuse  to  take  risks  on 
any  one  but  total  abstainers.  It  is  computed  that  for  every 
death  from  inebriety  there  are  at  least  fifty  cases  of  illness. 
Associated  with  this  are  premature  deaths,  starvation,  acci- 
dents, violence,  neglect,  until  tiie  loss  and  suffering  becomes 
appalling  in  magnitude  and  severity. 

Tlie  recent  outbreak  of  cholera,  with  its  extreme  fatality, 
recalls  the  mortality  amonginebriates  which  has  character- 
ized the  march  of  this  and  other  epidemics  in  modern  times. 

We  select  illustrative  statistics  of  the  ciiolera  epidemic 
of  1832.  In  St.  Petersburg,  out  of  10,000  deaths  only  145 
were  known  to  be  temperate  ;  in  Moscow,  only  2  out  of  6,000 
cases  were  temperate.  This  fact  so  alarmed  the  citizens  that 
nearly  all  the  population  ceased  to  use  alcohol  ;  of  30,000 
victims  in  Paris,  nearly  every  one  used  alcohol,  in  some  form, 
to  excess  ;  nine-tenths  of  those  who  died  in  Poland,  were  of 
this  class.  In  some  towns  every  inebriate  was  swept  away. 
In  Tififlis,  every  drunkard  died.  In  the  Park  Hospital  of 
New  York  city,  only  4  persons  were  temperate  in  200  fatal 
cases.  In  Albany,  there  were  only  7  out  of  326  fatal  cases 
who  were  not  inebriates.  In  the  late  epidemic  of  yellow- 
fever  in  the  South,  the  percentage  of  victims  among  inebri- 
ates was  nearly  as  large.  Tiiese  are  not  extraordinary 
facts,  but  follow,  naturally,  tlie  degeneration  produced  by 
alcohol,  and  are  readily  explained  by  the  low  vitality  and 
lessened  power  of  resistance  to  toxic  forces  and  agents 
present  in  every  inebriate.  Most  unfortunately,  this  con- 
dition is  not  realized  by  either  the  patient  or  friends  until 
it  is  too  late.  The  continued  use  of  alcohol  keeps  up  the 
delusion  of  strength  and  vigor  ;  but  with  the  onset  of  dis- 
ease all  is  thrown  off,  and  only  the  physician  and  surgeon 
can  realize  their  hopeless  condition. 


CHAPTER  XII. 

INEBRIETY     AND     CONSUMPTION  :,,  ITS     RELATION     AND 
CONNECTION. 

Any  one  who  studiously  watches  the  evolution  and  dis- 
solution of  families,  some  of  whose  members  are  addicted 
to  alcoholic  excess,  must  be  struck  with  the  frequent 
occurrence  of  pulmonary  phthisis  among  tiiem.  So  on  the 
other  hand,  it  is  no  less  astonishing  to  find  the  latter 
disease  suddenly  appearing  in  families  who  are  absolutel}'' 
free  from  a  phthisical  history,  and  who  seemingly  live 
amidst  the  most  healthful  surroundings.  Why  these  two 
conditions  should  be  so  closely  associated,  if  in  consonance 
with  the  current  belief,  the  one  is  a  nervous,  and  the 
other  a  strictly  pulmonary  disease,  is  not  very  clear.  The 
following  is  an  attempt  to  an  elucidation  of  this  intric- 
ate problem,  in  which  I  shall  endeavor  to  show  that 
these  two  apparently  isolated  phenomena  are  naturally 
interchangeable  with  each  other,  and  that  like  two  diversi- 
fied islands  cropping  out  above  the  surface  of  the  ocean 
without  exposing  their  connection  beneath,  they  find  their 
common  bond  of  union  in  a  disordered  state  of  the  nervous 
system. 

In  order  to  make  this  subject  as  practical  and  as  intel- 
ligible as  possible,  I  shall  at  the  very  outset  endeavor  to 
prove  the  intimate  association  between  alcoholism  and 
phthisis,  how  one  link  may  change  place  with  the  other  in 
the  chain  of  vital  persistence,  by  citing  a  number  of  living, 
illustrative  examples.  The  first  ten  of  these  cases  liave 
been  culled  from  the  extensive  experience  of  Dr.  Crotlieis, 

103 


104  DISEASES   OF   INEBRIETY. 

and  have  been  placed  at  my  disposal  through  his  kindness  ; 
while  the  remainder  have  been  obtained  from  various  other 
sources. 

Case  I.  J.  B.,  aged  42  years,  began  the  excessive  use  of 
spirits  after  the  death  of  his  wife.  He  was  a  merchant, 
temperate,  prosperous,  and  a  man  of  character.  He  became 
a  steady  drinker,  and  was  practically  intoxicated  all  the 
time.  After  an  attack  of  delirium  tremens  he  was  placed 
under  my  care.  During  the  four  months  while  under 
treatment,  he  was  alternately  depressed  and  elated.  He 
complained  of  wandering  pains,  and  changeable  appetite, 
as  well  as  of  spasmodic  periods  of  coughing.  A  few 
months  after  he  left  me,  he  relapsed  and  continued  to 
drink  until  he  died  a  year  later. 

His  mother  and  two  sisters  died  of  consumption.  His 
father  died  from  injury,  but  his  grandfather  was  asthmatic, 
and  used  spirits  to  excess  for  years.  One  uncle  on  his 
father's  side  died  from  excess  of  drink,  and  another  one 
died  of  consumption.  One  uncle  died  from  phthisis  after 
many  years  of  drink  excess. 

His  grandfather  on  his  mother's  side  drank  more  or  less 
all  his  life,  and  died  from  some  rheumatic  trouble. 

Case  II.  B.  A.,  aged  35,  a  mechanic,  began  to  use  spirits  for 
insomnia  and  general  debility,  and  finally  became  a  periodi- 
cal inebriate.  He  was  under  treatment  for  six  months,  and 
recovered.  His  father,  grandfather,  and  two  uncles,  died 
of  consumption.  His  mother  was  liysterical,  and  his  grand- 
mother on  his  mother's  side  died  of  some  lung  trouble.  One 
brother  died  from  chronic  alcoholism,  and  a  sister  is  a  drug- 
taker. 

Case  III.  C.  H.,  age  48,  an  army  officer,  began  to  drink 
during  the  late  war.  He  is  now  a  dipsomaniac,  with  dis- 
tinct free  intervals  of  three  months.  His  mother  died  of 
consumption  two  months  after  his  birth,  and  his  two  sisters 
died  of  the  same  disease.  His  father's  family  is  temperate, 
but  several  members  have  died  of  consumption.     His  grand- 


IKEBEIETf   AND   CONSUMPTION.  lOS 

father  on   his   mother's    side    was  a   sailor,  and   drank    to 
excess  at  times. 

Case  JV.  D.  P.,  age  38,  a  farmer.  His  drinking  seems 
to  date  from  a  nervous  shock  following  the  burning  of 
a  barn  by  lightning.  His  two  brothers  are  chronic  inebri- 
ates, one  sister  is  a  morphine  taker,  and  the  other  uses  both 
spirits  and  drugs  to  excess  for  all  kinds  of  imaginary  evils. 
On  his  mother's  side,  a  grandfather  and  three  aunts  and 
one  uncle  died  of  consumption.  His  mother  is  still  living. 
His  father  died  of  pneumonia,  and  his  grandmother  on  his 
father's  side  died  of  consumption. 

Case  V.  E.  J.,  age  31,  a  clerk  of  inferior  mental  and 
physical  development,  began  to  drink  at  puberty.  Con- 
sumption has  been  the  common  family  disease  of  both 
parents.  On  his  mother's  side  both  consumption  and 
inebriety  have  been  common.  On  his  father's  side  con- 
sumption alone  has  prevailed. 

Case  VI.  P.  O,,  age  28,  is  withont  business,  and  drank 
from  infancy.  He  is  now  a  chronic  inebriate  and  has  had 
delirium  tremens.  His  father  and  two  uncles  died  of  con- 
sumption. His  mother  is  a  woman  of  wealth  and  fashion, 
and  she  lost  her  mother  and  one  sister  from  consumption. 

Case  VII.  M.  B.,  a  lawyer,  54  years  old,  who  began  to 
drink  at  fifty  from  no  apparent  cause.  His  father  and 
grandfather  died  of  consumption  at  fifty  years  of  age. 

Case  VIII.  D.  T.,  age  38,  a  conductor,  began  to  drink 
after  an  injury  to  the  spine.  A  brother,  who  was  injured  at 
the  same  time,  died  of  consumption.  The  mother  and  a 
sister,  the  grandfather,  and  grandmother,  on  his  father's 
side,  all  died  of  consumption. 

Case  IX.  D.  B.,  24  years  old,  and  without  business, 
began  to  drink  at  puberty,  and  is  now  a  chronic  inebriate. 
Both  parents  died  of  consumption.  His  grandfather  on  his 
father's  side,  and  two  uncles  on  his  mother's  side,  died  of 
the  same  disease. 

Case  X.     A.  H.,  34  years  old,  a  physician,  took  morphia 


106  DISEASES    OF   INEBRIETY. 

for  malarial  poisoning,  and  then  used  alcohol  to  great 
excess.  His  mother  and  tiiree  uncles  on  his  father's  side 
died  of  consumption.  His  older  brother  became  an  inebri- 
ate at  about  thirty  years  of  age,  and  one  sister  is  in  Colo- 
rado to  prevent  consumption. 

Case  XI.  {Quarterly  Journal  of  Inebriety,  Oct.,  1888,  p.  390.) 
"George  Ulmercame  from  England  in  1798  and  settled  at 
New  Haven,  Conn.  He  was  a  harness-maker,  a  beer- 
drinker,  and  after  middle  life  drank  rum  to  excess,  until 
death  at  sixty-one  years  of  age.  His  wife  was  a  healthy 
woman,  and  lived  to  eighty  years  of  age.  Eight  sons  grew 
to  manhood  and  married.  Six  of  them  died  of  consumption 
under  forty-five  years  of  age.  One  v^^as  killed  by  an 
accident,  and  one  died  from  excessive  use  of  spirits.  Two 
daughters  grew  up  and  married  ;  one  died  of  consumption, 
the  other  in  childbirth.  They  left  four  children  ;  two  were 
inebriates,  and  the  others  were  eccentric  and  died  of  con- 
sumption. Of  the  children  of  the  eight  sons  only  ten  grew 
up  to  manhood.  Four  of  these  drank  to  excess  and  died. 
Three  of  the  six  remaining  died  of  consumption,  and  two 
others  were  nervous  invalids,  until  death  in  middle  life. 
The  last  one,  a  physician  of  eminence,  has  become  an 
inebriate  and  is  under  care  at  present.  He  is  the  only  sur- 
viving member  of  all  this  family.  The  male  members  of 
this  family  were  farmers,  tradesmen,  and  men  of  more  than 
average  vigor  in  appearance.  They  married  women  (so  far 
as  can  be  ascertained)  without  any  special  liereditary  his- 
tory of  consumption  or  inebriety." 

Case  XII.  Father  was  an  inebriate  until  after  he  w;is 
forty  years  old,  at  which  time  a  cardiac  affection  developed 
itself  from  which  he  ultimately  died,  but  which  had  the 
power  of  restraining  him  from  exercising  his  morbid  appe- 
tite. His  brother  was  a  drunkard  too.  Tliree  of  his  sons 
became  confirmed  alcoholics,  one  daughter  died  of  phthisis, 
and  another  son  died  of  general  paralysis. 

Case  XIII.  Father  violent,  an  alcoholic,  and  a  libertine. 


INEBKIETY   AND   CONSUMPTION.  107 

Mother  is  very  nervous,  and  died  of  cancer  of  the  uterus. 
Many  of  patient's  relations  are  drunkards.  Her  brotlierand 
sister  died  of  chest  disease,  and  another  brotlier  is  always 
ill,  and  coughs  a  great  deal.  She  was  admitted  May  3,  1879. 
One  month  previously  she  had  a  chill,  rigors,  and  feverish- 
ness,  which  confined  her  to  bed  for  four  days  ;  then  she 
began  to  cough,  and  had  two  copious  haemoptyses.  She 
sweats  profusely  at  night,  is  losing  flesh,  and  in  a  word  has 
all  the  symptoms  of  pulmonary  phthisis.  Physical  examin- 
ation shows  evidence  of  tuberculosis  of  both  apices. 

The  histories  of  these  cases  give  the  most  unmistakable 
proof  that  alcoholism  and  phtliisis  are  not  mere  coinci- 
dences, but  that  they  have  a  relationship  so  intimate  that 
one  may  be  converted  into  the  other.  The  problem  arises, 
however,  as  to  the  channel  through  which  alcohol  produces 
phthisis  ;  for  if  these  two  conditions  are  interchangeable,  it 
is  obvious  that  they  must  possess  a  common  physiological 
basis,  and  this  I  believe  resides  in  the  nervous  system.  I 
have  elsewhere  (to  which  I  beg  to  refer  the  reader)  given 
good  reason  for  believing  that  pulmonary  phthisis  is  prin- 
cipally nervous  in  character,  and  by  considering  it  as  such, 
tlie  natural  association  between  the  two  diseases  is  at  once 
established.  For  whatever  else  may  be  said  of  the  action  of 
alcohol,  it  is  pretty  generally  understood  that  it  possesses  a 
special  affinity  for  the  nervous  system,  and  that  it  produces 
its  principal  ravages  in  the  body  by  operating  on  this,  and 
by  preference  on  the  peripheral  nervous  tissue.  Dr.  James 
Jackson,  in  this  country,  and  Dr.  Wilks,  in  England,  were  I 
believe  the  first  to  point  out  this  form  of  disease,  and  they 
called  it  alcoholic  paralysis.  It  has  since  then  received  the 
more  appropriate  name  of  alcoholic  neuritis,  and  it  is  charac- 
terized in  its  early  stages  by  numbness,  tingling,  hyperses- 
thesia  in  the  extremities,  and  later  on  by  anoesthesia,  par- 
alysis of  motion,  loss  of  knee  jerk,  quickened  pulse,  short- 
ness of  breath,  and  frequently  by  pulmonary  embarrass^ 
ment.     The    brain  and  spinal  cord    remain  comparatively 


108  DISEASES    OF   INEBRIETY. 

normal.  The  morbid  changes  occurring  in  the  peripheral 
nerves  under  the  influence  of  alcohol  are  parenchymatous 
and  interstitial,  or  in  other  words  they  are  confined  to  the 
nerve  substance  itself,  or  to  its  investing  membrane.  As  a 
rule  these  changes  occur  together,  tiie  latter  in  many 
instances  depending  on  the  former,  but  frequently  one 
exists  exclusively  of  the  other  ;  especially  is  this  true  of  the 
degeneration  of  the  nerve  fibre  itself. 

It  being  established,  then,  that  alcohol  has  the  power  of 
producing  degeneration  of  the  nerve  fibres,  it  does  not 
require  a  reckless  fiiglit  of  fancy  to  see  how,  by  operating 
on  the  same  tissue,  it  may  bring  about  that  peculiar 
destruction  of  lung  substance  known  as  pulmonary  con- 
sumption. Degeneration  of  a  nerve  implies  degeneration 
of  the  organ  which  it  supplies  witii  sensation  and  motion. 
Thus,  degeneration  of  the  sciatic  nerve  is  followed  by 
impairment  of  sensation  and  motion  in  the  muscles  and 
other  textures  of  the  leg — a  condition  which  is  almost  con- 
stantly present  in  chronic  alcoholism,  and  degeneration  of 
the  pneumogastric  nerves  is  just  as  naturally  followed  by 
disease  of  the  lungs,  heart,  stomacli,  and  all  the  other 
organs  supplied  by  them.  This  is  no  more  than  we  may 
legitimately  anticipate  ;  for  it  has  been  amply  proven  that 
division  of,  and  protracted  pressure  of  tumors,  aneurisms, 
etc.,  on  the  pneumogastric  nerves  are  capable  of  calling 
forth  all  the  destructive  lesions  of  pulmonary  phthisis. 

The  following  cases  will  serve  to  illustrate  the  close 
anatomical  and  physiological  association  of  chronic  alco- 
holism and  phthisis,  as  well  as  other  destructive  pulmonary 
charges  with  degeneration  of  the  vagii,  and  of  the  respira- 
tory center  (the  latter  of  which  practically  amounts  to  the 
same  thing),  and  with  that  of  the  peripheral  nerves.  The 
ditficulty  encountered  in  this  research  has  not  been  so  much 
in  obtaining  an  abundance  of  material  in  which  phthisis 
was  evidently  the  direct  result  of  alcoholic  abuse,  as  it  has 
been  in  finding  the  records  of  cases  possessing  all  the  points 


INEBRIETY    AND    CONSUMPTION.  109 

which  I  desire  to  emphasize  in  this  paper,  viz.:  the  coexist- 
ence of  pulmonary  disintegration,  alcoliolism,  and  nerve 
degeneration,  well  brought  out  by  a  tliorough  post  mortem 
demonstration. 

Case  XIV.  Drs.  Oppenheim  and  Siemerling.  Male, 
addicted  to  alcoholic  excess,  was  received  in  hospital  Jan. 
26,  1886.  He  was  weak  and  stiff,  but  had  no  pain.  At  the 
end  of  the  same  month  he  became  delirious,  and  also  paretic 
in  both  legs  and  arms.  Death  occurred  in  March  of  the 
same  year.  On  section  it  was  shown  that  the  heart  was 
normal,  and  that  he  had  pneumonia  ;  microscopically  it  was 
proven  that  the  radial,  peroneus,  and  saphenous  nerve  had 
undergone  degeneration.  Not  stated  whether  the  vagii 
were  examined  or  not. 

Case  XV.  Drs,  Oppenheim  and  Siemerling.  A  female, 
^gs  45  years,  suffering  from  chronic  alcoholism,  was 
received  Dec.  26th,  and  died  on  the  28tli  of  the  same  month, 
in  the  year  1885.  On  section  there  was  found  chronic  exud- 
ative pleurisy  on  right  side,  as  well  as  a  caseous  broncho- 
pneumonia and  tracheitis.  The  great  saphenous  and  super- 
ficial peroneus  nerves  liad  undergone  parenchymatous 
degeneration  of  a  medium  degree.  No  otlier  nerves  were 
examined. 

Case  XVI.  Dr.  T,  Dejerine.  Female,  age  46,  a  hard 
drinker,  suffered  from  paralysis  of  both  upper  and  lower 
extremities.  Had  a  pulse  of  150-160,  and  her  heart  sounds 
were  normal.  Her  death  was  caused  by  pneumonia.  Sec- 
tion showed  parenchymatous  neuritis  of  the  cutaneous  and 
muscular  nerves,  as  well  as  of  both  vagii  in  the  cervical 
region. 

Case  XVII.  Prof.  Schultze.  Male,  39  years  old,  devel- 
oped diabetes  insipidus  in  1882,  but  had  been  feeble  since 
childhood.  He  used  alcohol  greatly  to  excess  in  his  younger 
days.  Some  time  after  the  year  1882,  he  began  to  suffer 
from  nystagmus,  trembling  in  the  arms,  perversion  of  sen- 
sation (paraesthesia)  in  the  legs,  and  from  thoracic  constric- 


110  DISEASES    OF   INEBRIETY. 

tion.  In  1886  he  became  subject  to  marked  attacks  of 
dyspnoea,  and  death  was  caused  by  paralysis  of  respiration. 
Section  :  Degeneration  of  medulla  oblongata  and  spinal 
cord,  as  well  as  that  of  tlie  root  of  the  vagus  and  hypo- 
glossus.  No  account  of  the  post  mortem  appearances  of  the 
lungs  is  given,  but  it  is  evident  that  these  organs  were 
implicated  in  the  morbid  processes,  since  death  was  pro- 
duced through  pulmonar}""  paresis. 

Case XVIII.  Striimpbell.  Male,  aged  47  year,  a  potator, 
was  received  November  25,  1881.  His  frame  is  large  and 
powerful.  Both  of  his  arms  hang  helplessly  by  his  side  ; 
hands  cedematous,  skin  and  tendon  reflexes  wanting  ;  legs 
weak  and  powerless  ;  pulse,  124  ;  temp.  38.2°  ;  deglutition 
and  power  of  speech  impaired  ;  after  a  while  oedema  of 
lower  extremities,  cough,  diarrhoea,  dyspnoea  ;  bronchial 
rSles,  paralysis  of  diaphragm,  and  death,  Feb.  13,  1882. 
Section:  Marked  tubercular  phthisis  of  both  lungs.  The 
radial  median,  crural,  and  sciatic  nerves  were  degenerated 
very  decidedly,  and  Dr.  Striimpbell  believes  that  the  phrenic 
and  vagii  were  also  involved,  but  he  failed  to  examine 
them  closely. 

Case  XIX.  Drs.  Oppenheim  and  Siemer.ling.  Male,  26 
years  old,  a  potator,  was  received  in  the  Charity  Hospital 
Jan.  17,  1881,  on  account  of  delirium  tremens.  He  com- 
plained of  headache,  giddiness,  and  formication  in  the  legs. 
He  improved  and  was  dismissed,  but  was  received  again  on 
July  28,  1883,  on  account  of  marked  disturbances  in  the 
nervous  system.  He  now  suffered  from  complete  impo- 
tence, lancinating  pains  and  rectal  tenesmus.  In  August, 
he  became  subject  to  polydipsia  and  polyuria;  on  the  12th 
of  December,  there  ivas  dullness  in  left  supra  clavicular 
fossa,  and  infiltration  of  both  apices  and  tubercle  bacilli 
were  found  in  the  sputum.  He  gradually  sank  and  died  in 
August.  Microscopic  examination  showed  degeneration  of 
the  medulla  oblongata,  and  of  all  the  peripheral  nerves 
which  were  examined. 


INEBKIETT    AND    CONSUMPTION.  Ill 

Case  XX.  Dr.  Oswald  Vierordt.  Male,  30  years  old, 
much  addicted  to  alcoliol,  and  without  a  syphilitic  history, 
suffered  since  Marcli,  1884,  witli  piercing,  lightning  pains  in 
the  lower  extremities,  as  well  as  with  weakness,  unsteadi- 
ness, and  formication  in  the  same.  He  also  developed 
tubercular  phthisis  and  died  the  following  March.  Section  : 
extended  tuberculosis  of  the  lungs  and  degeneration  of  the 
columns  of  Goll,  medulla  oblongata,  and  the  cervical  and 
dorsal  portions  of  the  spinal  cord. 

Case  XXI.  Mr.  Siiarkey  {^British  Medical  Journal,  1888, 
April  21,  and  Journal  of  Inebriety.,  Jan.,  1889,  p.  67)  related 
a  case  of  alcoholic  paralysis  of  the  phrenic,  pneumogastric 
and  other  peripheral  nerves  before,  and  presented  specimens 
of  the  same  to  the  Pathological  Society  of  London.  The 
patient  was  a  female  and  addicted  to  the  excessive  use  of 
alcohol.  She  suffered  from  weakness  in  her  legs,  numbness 
and  cramps,  and  was  incoherent  in  speech.  Respiratory 
sounds  were  harsh,  and  in  a  few  days  after  admission  had 
a  rigor,  which  was  followed  by  a  temperature  of  102.8^, 
severe  attacks  of  dyspnoea,  paralysis  of  the  diaphragm,  and 
difficulty  in  swallowing.  Respiration  40  per  minute,  and 
average  pulse  rate  140.  Spitting  of  blood  supervened,  the 
lung  apices  began  to  break  down,  and  she  died  after  having 
been  under  observation  nearly  one  montii.  Section  :  tuber- 
culosis of  botli  apices  and  inflammatory  changes  in  the 
piirenic,  pneumogastric,  and  popliteal  nerves. 

In  these  examples  we  have  proof  that  pulmonary  phthisis 
can  be  produced  through  the  toxic  action  of  alcohol  on  the 
nervous  system.  This  is  unquestionable  in  four  of  the 
cases,  and  in  so  far  as  demonstrating  the  mode  of  tlie  action 
of  alcohol  on  the  human  lungs  is  concerned,  it  is  equally 
true  of  the  other  cases  ;  for  I  think  it  is  pretty  well  estab- 
lished that  phthisis  is  but  the  legitimate  offspring  of  any 
persistent  catarrhal  state  of  the  lungs,  and  that  clironic 
bronchitis  and  catarrhal   and   broncho-pneumonia,  are  bat 


112  DISEASES    OF    INEBRIETY. 

the  milestones  marking  the   pathway  along  which    the  dis- 
ease travels  to  its  final  destination. 

Such  then  being  the  relation  between  alcoholism  and  pul- 
monary phthisis  it  is  very  readily  understood  why  these  two 
diseases  should  so  frequently  change  places  in  different 
members  or  generations  of  the  same  family,  and  why  they 
are  so  often  associated  with  various  other  nervous  dis- 
orders. Moreover,  alcohol  having  the  potency  to  produce 
phthisis  de  novo  in  the  human  subject,  either  directly  or 
through  hereditary  influence,  or  both,  as  we  have  seen,  it 
must,  in  view  of  its  past  and  present  widespread  abuse  in 
civilized  countries,  be  a  tremendous  factor  in  maintaining 
the  ranks  of  the  hundreds  of  thousands  of  those  who  are 
annually  slain  by  this  terrible  malady.  To  this  and  to  no 
other  conclusion  do  the  premises  of  this  paper  point,  and 
if  one  had  the  inclination  to  moralize  on  this  subject  it 
would  be  very  interesting  to  inquire  why  the  North  Ameri- 
can Indian,  and  other  savages,  were  practically  free  from 
pulmonary  consumption  until  they  came  in  contact  with 
tlie  white  race  !  When  we  connect  the  facts  that  alcohol 
and  syphilis  are  the  greatest  curses  which  the  Indian  has 
acquired  from  his  white  civilizer,  with  the  evidence  which 
has  been  brought  forward  in  this  as  well  as  in  another 
paper  on  Syphilitic  Phthisis,  I  think  it  must  be  obvious  that 
these  two  causes  are  largely  responsible  for  sowing  the 
seeds  of  pulmonary  phthisis  among  these  people. 


CHAPTER  XIII. 

EFFECTS  OF  ALCOHOL  AND   BEER  ON  MENTAL  FUNCTIONS 
AND   THE   BRAIN. 

The  effects  of  a  single  dose  of  alcohol  differ  widely  in 
different  individuals,  and  this  lies  at  the  root  of  all  scientific 
inquiries  into  the  matter.  The  variety  of  the  effects  on  the 
mental  faculties  of  different  brains  is  also  extreme.  This 
indicates  such  different  qualities  and  susceptibilities  in  dif- 
ferent brains  as  regards  this  agent,  that  it  makes  the  whole 
question  of  the  effects  of  alcohol  a  most  complicated  one, 
not  to  be  explained  by  a  few  unqualified  assertions.  In 
reply  to  the  question,  What  are  the  normal  effects  of  alcohol 
on  the  mental  forces  of  the  brain  ?  the  scientific  man  must 
reply.  What  k4nd  of  brain  do  you  mean  ?  and  it  is  only  by  a 
careful  study  of  the  qualities,  the  tendencies,  and  potential- 
ities of  different  brains,  that  we  can  answer  the  first  question 
properly.  We  need  to  study  the  mental  qualities  of  the 
brain  at  different  periods  of  life,  in  the  two  sexes,  in  differ- 
ent temperaments  and  constitutions,  in  different  races,  in 
different  states  of  healtii  and  vigor,  and  with  reference  to 
the  hereditary  tendencies  of  the  organ  ;  for  all  these  things 
influence  the  effects  of  one  single  small  dose  of  alcohol.  So 
we  find,  looking  from  the  point  of  view  of  the  amount  of  the 
doses,  the  effect  is  very  different.  There  is,  I  believe,  no 
other  agent  known  which  differs  so  greatly  in  different  in- 
stances in  the  dose  needed  to  produce  the  same  effect  on 
the  mental  powers  as  a  dose  of  alcohol,  and  herein  again  we 
find  that  there  must  be  the  greatest  difference  in  the  power 
of  resisting  the  effects  of  alcohol  in  different  brains.     Tak- 


114  DISEASES    OF   INEBRIETY. 

ing  tlie  lower  animals,  that  difference  is  exceedingly  small, 
an  ounce  of  alcoliol  given  to  a  dozen  dogs  of  tlie  same  size 
will  practically  have  the  same  effect  on  them  ail  ;  but  an 
ounce  given  each  to  a  dozen  men  has  not  only  the  most  dif- 
ferent effects  in  the  mental  faculties  it  stimulates,  as  we 
have  seen,  but  in  the  amount  of  the  effect  it  causes.  Some 
brains  are  exceedingly  sensitive  to  very  small  quantities  ; 
other  brains  have  the  power  of  resisting  or  tolerating  alco- 
hol in  a  wondrous  degree,  this  being  an  innate  quality  quite 
apart  from  the  effect  of  the  use  and  custom.  These  differ- 
ences are  so  great  as  to  compel  us  to  conclude  that  there 
are  enormous  inherent  disparities  in  human  beings  in  this 
respect,  and  this  is  no  doubt  one  of  the  very  great  dangers 
in  the  use  of  alcoliol. 

So  we  also  find  at  the  various  periods  of  life,  ordinary 
small  doses  of  alcohol  have  very  different  effects.  In  a 
child  the  effect  is  extremely  great,  in  a  boy  or  girl 
it  is  also  great,  but  it  is  not  so  great  in  a  growing  adoles- 
cent. In  the  two  sexes  there  are  also  considerable  differ- 
ences, the  female  having  less  resisting  power,  her  brain 
being  unusually  much  more  susceptible  to  'the  influence 
of  this  agent.  Looking  at  different  races,  the  differ- 
ence of  effect  of  the  same  dose  is  also  extremely  great 
There  are  some  savage  races  that  are  so  subject  to  its  influ- 
ence that  a  very  small  dose  indeed — half  an  ounce — will 
have  greater  effect  on  them,  than  two  or  three  ounces  will 
have  on  an  ordinary  European.  The  psychological,  the 
mental  effects  of  small  doses  of  alcohol  are  therefore  exceed- 
ingly various,  and  we  have  not  yet  discovered  the  precise 
qualities  of  brain  which  caused  these  differences.  We  can 
not  tell  beforehand  which  brain  will  be  susceptible  to  its 
effects,  and  which  will  not.  Looking  at  the  matter  next 
from  a  point  of  view  of  the  effects  of  a  much  larger  dose, 
these  will  be  found  much  more  uniform.  The  effect, 
instead  of  being  stimulating,  is  then  narcotic,  and  we  have 
a  deadening,  paralyzing  and   temporary  arrestment  of  the 


EFFECTS   OF  ALCOHOL   ON  MENTAL   FUNCTIONS.  115 

mental  functions  of  the  brain  in  every  individual  if  a  suffi- 
cient quantity  is  taken.  But  here  we  find  much  variety  in 
the  way  tlie  result  is  arrived  at,  when  carefully  studied. 

In  one  person  we  have  this  paralysis,  this  deadening 
taking  place  first  on  the  intellectual  faculties,  in  another  on 
the  emotional,  in  another  on  the  propensities,  and  in 
another  on  the  power  of  motion.  We  see  a  certain  kind  of 
mental  degeneration  of  a  slight  type,  which  results  in  those 
who  habitually  take  an  amount  of  alcohol  that  is  to  them 
excessive.  This  slow  but  quite  marked  type  of  mental 
degeneration  a  doctor  of  experience  soon  comes  to  observe 
in  his  patients  ;  and  others  a  certain  change  mentally, 
morally,  and  bodily,  in  the  man  who  is  taking  more  than 
is  good  for  him.  The  expression  of  his  face  and  eyes — 
those  mirrors  of  the  mind — you  see  has  changed,  and  for 
the  worst.  The  mental  condition  of  the  man  is  lowered  all 
round,  and  especially  one  effect  is  noticed,  that  his  higher 
power  of  control  is  lessened,  I  am  safe  in  saying  that  no 
man  indulges  for  ten  years  in  more  alcohol  than  is  really 
good  for  him,  without  this  kind  of  degeneration  being 
observed,  and  that  although  during  these  ten  years  he  was 
never  once  drunk,  we  find  him  psychologically  changed  for 
the  worse  in  his  independence  of  mind,  in  his  spontaneity. 
After  a  man  has  passed  forty,  such  changes  are  very  apt  to 
be  faster,  and  more  decided.  We  see  such  a  man's  work 
and  his  fortune  suffering,  but  we  dare  not  call  him  either 
a  drunkard  or  dissipated,  because,  as  a  matter  of  fact  he  has 
never  been  drunk,  and  never  intends  to  be  drunk.  Whether 
this  degeneration  takes  place  soon  or  late  depends  upon 
inherent  resistive  capacities  of  his  brain  cells.  In  some 
individuals  the  resistive  capacity  against  alcohol  is  so  great 
that  for  years  they  may  indulge  in  its  excessive  use  without 
this  degeneration  taking  place  to  any  great  extent,  but  in 
other  instances  we  have  it  very  i-apidly  developed  indeed. 

Some  men  pass  into  a  premature  old  age  and  become  old 
at  fifty,  when  they  ought  to  have  lived  on  and  been  young 


116  DISEASES    OF    INEBRIETY. 

men  up  to  sixty,  and  this  merely  owing  to  tlie  excessive  use 
of  alcohol.  Memory  and  the  power  of  thinking  are  affected, 
but  you  see  the  lowering  most  in  the  finer  faculties,  the 
tastes,  the  more  delicate  perceptions  of  things,  and  the  force 
of  character.  This  is  an  effect  which,  I  believe,  is  especi- 
ally to  be  observed  in  men  who  have  used  their  intellectual 
powers  constantly  and  vigorously.  We  often  see  this  effect 
on  the  brains  of  men  in  our  profession,  of  medicine,  at  the 
bar,  and  even  among  the  clerical  profession,  in  a  very  marked 
degree,  without  their  owners  having  been  once  drunk.  In 
such  persons,  their  mental  powers  having  been  greater  to 
begin  with,  and  with  a  finer  edge  on  them,  you  notice  in  a 
more  marked  way  this  degeneration  in  its  progress.  This, 
I  may  say,  is  the  least  marked  mental  effect  of  alcohol 
taken,  not  so  as  to  produce  drunkenness,  but  taken  in 
greater  quantity  than  the  physical  constitution  of  the  brain 
can  stand  over  a  long  period.  In  some  brains  a  very  small 
quantity  indeed,  taken  daily,  will  produce  this  degen- 
eration. 

For  some  years  past  a  decided  inclination  has  been 
apparent  all  over  this  country,  to  give  up  the  use  of  whisky 
and  other  strong  alcohols,  using  as  a  substitute,  beer 
and  bitters  and  other  compounds.  This  is  evidently 
founded  on  the  idea  that  beer  is  not  harmful  and  contains 
a  large  amount  of  nutriment  ;  also  that  bitters  may  have 
some  medicinal  quality,  which  will  neutralize  the  alcohol  it 
conceals,  etc.  These  theories  are  without  confirmation  in 
the  observations  of  physicians  and  chemists  where  either  has 
been  used  for  any  length  of  time.  The  constant  use  of  beer 
is  found  to  produce  a  species  of  degeneration  of  all  the 
organism,  profound  and  deceptive.  Fatt}'^  deposits,  dimin- 
ished circulation,  conditions  of  congestion,  and  perversion 
of  functional  activities,  local  inflammations  of  both  the  liver 
and  kidneys,  are  constantly  present.  Intellectually,  a  stupor 
amounting  almost  to  paralysis  arrests  the  reason,  pre- 
cipitating all  the  higher  faculties  into  a  mere  animalism  ; 


EFFECTS   OF   ALCOHOL   ON   MENTAL   FUNCTIONS.  117 

sensual,  selfish,  sluggish,  varied  only  with  paroxysms  of 
anger,  that  are  senseless  and  brutal  ;  in  appearance  the 
beer-drinker  may  be  the  picture  of  health,  but  in  reality  he 
is  most  incapable  of  resisting  disease.  A  slight  injury, 
severe  cold,  or  shock  to  the  body  or  mind,  will  commonly 
provoke  acute  disease,  ending  fatally.  Compared  with 
inebriates,  who  use  different  forms  of  alcohol,  he  is  more 
incurable,  and  more  generally  diseased.  The  constant  use 
of  beer  every  day  gives  the  system  no  time  for  recupera- 
tion, but  steadily  lowers  the  vital  forces  ;  it  is  our  observa- 
tion that  beer-drinking  in  this  country  produces  the  very 
lowest  forms  of  inebriety,  closely  allied  to  criminal  insanity. 
The  most  dangerous  class  of  tramps  and  ruffians  in  our 
large  cities  are  beer-drinkers.  It  is  asserted  by  competent 
authority  that  the  evils  of  heredity  are  more  positive  in  this 
class  than  from  alcoholics.  If  these  facts  are  well  founded, 
the  recourse  to  beer  as  a  substitute  for  alcohol,  merely 
increases  the  danger  and  fatality  following. 

In  bitters  we  have  a  drink  whicii  can  never  become  gen- 
eral ;  but  its  chief  danger  will  be  in  strengtliening  the  dis- 
ordered cravings,  which  later  will  develop  a  positive  disease. 
Public  sentiment  and  legislation  should  comprehend  that 
all  forms  of  alcohol  are  more  or  less  dangerous,  when  used 
steadily  ;  and  all  persons  who  use  them  in  this  way,  should 
come  under  sanitary  and  legislative  control. 


CHAPTER   XIV. 

CLIMATIC  PERIOD — DIAGNOSIS  OF  INEBRIETY  AND  STUDY 
OF  SOCIAL  STATISTICS. 

"  There  is  a  natural  tendency  in  our  very  life  to  find  a 
settled  cliannel  in  which  its  forces  may  flow.  So  conscious 
are  we  in  the  earlier  periods  of  our  adult  life  of  the  exist- 
ence of  strong  and  opposing  passions  and  tendencies,  that 
we  are  apt  to  accept  as  an  axiom  the  common  expression 
that  '  character  is  not  formed  until  forty.'  Physical  factors 
are  all  the  time  at  work  to  develop  and  mature  what  is  in, 
and  of  us,  and  it  is  not  until  maturity  is  reached  that 
a  definite  and  uniform  channel  is  wrought  out  and 
established.  This  age  of  maturity  is  not  and  cannot  be 
determined  according  to  a  uniform  rule,  but  just  as  the 
sexual  instinct  has  its  time  of  beginning  and  ending,  so 
other  elements  have  a  similar  history." 

Again,  "  There  comes  a  time  in  the  course  of  one's  life 
when  the  forces  that  have  been  engaged  in  structural  repair 
and  waste  come  as  to  a  stand-still,  and  consult  together  as 
to  which  shall  be  dominant  in  the  future.  Some  of  the 
organs  may  be  said  to  rest  entirely  after  a  certain  age  ; 
rest  by  a  cessation  of  function,  and  become  atrophied  also  ; 
some,  that  do  not  rest  absolutely,  undergo  a  modification  of 
functional  activity.  It  is  at  this  slack-water  period — at  the 
middle  of  life — when  the  molecular  deposits  in  the  organic 
structure  are  different  in  quality  than  formerly,  that  we 
look  for  a  different  product." 

The  craving  for  drink  is  not  a  craving  of  childhood,  it 
does  not  usually  declare  itself  until  the  demands  on  the 
nervous  system  begin  to  be  exorbitant,  and  its  terminal 
ii8 


CLIMATIC   PERIOD.  119 

period  comes   with    as    much    certainty  as  does  its  initial  stage. 
That  terminal  period  is  the  climacteric  period. 

Many  years  ago  Dr.  Parrish  called  attention  to  this 
thought,  and  urged  those  who  had  opportunity  to  observe 
to  note  the  period  of  life  when  the  largest  number  of  reform- 
ations or  cures  of  inebriety  were  accomplished,  and  stated 
that  he  believed  they  would  be  found  between  the  ages  of 
forty  and  fifty.  Subsequent  observation  has  confirmed  his 
view.  ''^Between  these  ages  especially  do  recoveries  that  are  spon- 
taneous occur,  and  statistics  show  that  by  far  the  greater 
number  of  persons  first  exhibit  the  alcoholic  proclivity 
between  the  ages  of  fifteen  and  twenty-five,  and  though 
unable  to  verify  the  statement  by  figures,  he  was  convinced 
that  the  allowance  of  twenty-five  years  of  use  will,  in  most 
cases,  close  the  drinking  career,  either  by  exhaustion  of  the 
desire,  or  by  the  fatal  teimination  of  the  individual  life.  He 
thought  it  will  be  found  also,  that  when  inebriates  have 
lived  beyond  the  middle  period  of  life,  so  as  to  attain  the 
three  or  four-score  limit,  the  commencement  of  the  drink- 
ing career  was  considerably  later  in  life  than  the  average 
period  named." 

Dr.  Mason  from  a  careful  study  of  six  hundred  cases  in 
this  country  and  one  hundred  and  fifty-two  treated  in  Eng- 
land, found  the  greatest  liability  to  be  from  30  to  40,  and 
after  45  or  50  the  decline  in  the  drink  curse  was  very  rapid. 
Dr.  Kerr  found  that  this  period  was  from  55  to  60.  Other 
observers  agree  that  a  time  occurs  in  each  case  where  the 
possibility  of  the  subsidence  of  the  drink  curse  is  favored 
by  such  a  period. 

In  the  early  stage  of  inebriety  the  diagnosis  of  the  dis- 
ease is  extremely  difficult.  There  are  no  physical  signs 
upon  vvhicli  the  examiner  can  rely.  He  must  draw  all  the 
facts  on  wliich  to  form  his  opinion  from  the  applicant  him- 
self or  his  friends,  neither  of  whom  are  likely  to  conscien- 
tiously confess  tlie  truth.  Tlie  applicant  himself,  as  a  gen- 
eral rule,  is  ignorant  of  tlie  fact  of  disease,  and  will  account 


120  DISEASES   OF   INEBRIETY. 

for  his  personal  habits  in  some  other  way.  Fortunately,  if 
he  is  not  tlioroughly  posted  in  regard  to  tlie  symptoms  of 
the  disease,  he  will  unwittingly  betray  the  trutli  by  the 
revelation  he  will  make  of  his  habits. 

First  of  all,  it  must  be  borne  in  mind  that  the  inebriate 
is  a  chronic  deceiver,  and  cannot  be  depended  upon  to  tell 
the  truth. 

His  testimony  is  not  to  be  relied  on  even  under  oath 
when  there  is  a  motive  to  deceive,  unless  there  are  corrobo- 
rating circumstances  to  sustain  it.  Impairment  of  the  moral 
perceptions  is  one  of  the  first  symptoms  of  the  disease,  and 
is  also  an  obstacle  to  a  correct  diagnosis. 

An  inebriate  never  sees  himself  as  others  see  him.  If  he 
did  there  would  be  more  hope  in  his  case. 

The  heredity  of  the  applicant  should  be  carefully  inquired 
into.  No  man  is  a  good  risk  if  he  uses  alcohol  in  any  form, 
or  to  any  extent  ;  if  he  has  an  inheritance  of  inebriety, 
insanity,  epilepsy,  or  any  other  form  of  neurasthenia,  no 
matter  what  a  man's  present  habits  of  indulgence  may  be, 
he  will  not  be  able  to  adhere  to  a  temperate  use  for  any 
great  length  of  time.  It  is  a  recognized  fact  that  three-fifths 
of  all  the  persons  who  use  alchoholic  liquors  between  twenty 
and  thirty  become  inebriates  ;  and  the  inference  that  per- 
sons of  such  a  heredity  who  indulge  in  alcoholic  stimulants 
will  become  inebriates,  amounts  to  almost  a  certainty. 
Careful  inquiry  will  elicit  the  fact  that  such  persons  use 
alcoholic  drinks  because  they  like  them,  because  the  effect, 
if  not  the  taste,  is  agreeable,  A  man  may  like  claret  because 
it  relieves  his  thirst,  or  he  may  like  beer  because  it  gives 
him  an  appetite  ;  or  he  may  indulge,  in  a  company  of  friends, 
for  the  sake  of  sociability  or  hospitality,  and  it  may  not  be 
considered  a  symptom  of  inebriety.  But  when  it  is  evident 
that  the  man  drinks  because  the  specific  effects  of  alcohol 
are  especially  agreeable  to  him,  he  must  become  a  total 
abstainer,  or  it  will  be  only  a  question  of  time  when  he  will 
become  a  confirmed  inebriate. 


CLIMATIC   PERIOD.  121 

A  positive  dislike  or  aversion  to  the  use  of  alcoholic 
drinks  at  certain  intervals,  and  a  strong  desire  for  them  at 
other  periods,  is  often  a  characteristic  of  the  inebriate 
diathesis.  Wlien  an  admission  is  made  of  an  occasional 
indulgence  to  excess,  it  is  very  important  to  know  why  it  is 
occasional,  or  what  tlie  occasion  is.  If  it  is  periodic,  or  at 
somewhat  regular  intervals,  it  must  be  regarded  as  evidence 
of  disease. 

An  abnormal  desire  for  alcoholic  drinks,  however  mani- 
fested, is  an  evidence  of  disease.  If  the  diseased  condition 
has  once  been  establislied,  it  is  always  liable  to  return  ;  and 
tlie  percentage  of  exceptions  in  favor  of  permanent  cure  is 
so  very  small  that  a  period  of  abstinence  for  one  or  more 
years  does  not  make  the  applicant  a  safe  risk.  Men  who 
have  had  alcoholism,  dipsomania,  or  delirium  tremens,  and 
have  reformed  to  such  an  extent  as  to  be  total  abstainers, 
for  any  considerable  period,  go  down  very  rapidly  if  they 
return  to  their  old  liabits. 

Under  such  circumstances  their  prospect  of  life  is  very 
low  ;  not  more  than  four  or  five  years  at  most  in  the  majority 
of  cases. 

All  cases  of  inebriety  may  be  classed  as  persons  of  unde- 
veloped, degenerate,  and  disordered  minds.  Tlie  first  class,  the 
undeveloped,  represents  all  grades  of  defective,  retarded 
growths,  sometimes  seen  in  external  conformations  of  head 
and  body.  Grades  of  ancestral  defects  and  brain  failures, 
seen  in  faulty  acts  and  thoughts.  The  second  class,  of 
degenerate  brains,  are  those  who  are  retrograding  both  in 
mind  and  body.  Such  cases  frequently  date  from  illness, 
injuries,  shock,  diseases  of  all  kinds,  and  diseases  of  old 
age,  and  of  the  nerve  centers.  The  third  class,  the  disor- 
dered brains,  are  those  who  from  ill-health,  bad  conditions 
of  living  and  surroundings,  have  developed  inebriety. 
Such  cases  cannot  bear  the  strains,  drains,  or  any  extreme 
circumstances,  which  tax  the  energies  and  vigor  of  the 
body.     In    all   these    cases,  inebriety  starts  from   unknown 


122  DISEASES    OF    INEBRIETY. 

States  and  exciting  causes,  and  these  marked  physical 
conditions  are  both  primary  and  secondary.  Inebriety  is 
always  disease  and  degeneration,  and  the  fact  often  disputed 
is,  can  this  disease  be  traced  in  any  uniformity  of  symptoms 
or  progress?  Dr.  Jackson  has  clearly  pointed  out,  that  all 
disease  follows  a  regular  retrograde  march,  which  can  be 
outlined  and  studied  as  clearly  as  growth  and  development. 
Inebriety  is  no  exception  to  the  rule. 

The  frequent  instances  where  inebriates  in  apparent 
possession  of  good  judgment,  go  away  and  drink  to  great 
excess,  displaying  a  degree  of  forethought  and  premeditation 
fully  characteristic  of  all  the  ordinary  events  of  life,  are  often 
very  confusing  to  the  ordinary  observer.  When  the  drink 
paroxysm  comes  all  unexpectedly  upon  the  victim,  in  some 
unforeseen  state  and  circumstance,  and  he  falls,  it  is  dimly 
apparent  that  he  is  suffering  from  some  unstable  or  diseased 
brain  state,  which  has  burst  out  from  the  application  of  some 
exciting  cause.  But  when  the  paroxysm  is  anticipated  and 
prepared  for,  and  all  the  surroundings  are  made  subservient 
to  this  end,  when  every  facility  to  procure  spirits  are 
increased,  when  money  is  secured  and  business  arrange- 
ments are  made  in  view  of  this  coming  paroxysm,  the  con- 
clusion most  commonly  reached  by  all  non-expert  observers 
is  that  it  is  deliberate  vice  and  wickedness.  When  the  his- 
tories of  a  number  of  these  cases  are  studied  and  compared, 
they  are  found  to  be  well-marked  cases  of  reasoning  insan- 
ity, with  drink  paroxysm.  These  paroxysms  are  the  acute 
attacks — the  deliriums  wliich  expend  thejnselves  like  storms 
that  gather  and  burst — and  are  preceded  by  long  periods 
of  rest.  A  typical  case  is  that  of  a  banker,  who  is  a  man  of 
excellent  judgment  in  all  business  and  social  matters.  He 
will  prepare  for  a  week  or  ten  days  in  advance  for  a  drink 
paroxysm.  He  is  a  temperance  advocate,  yet  he  will 
display  great  cunning  to  conceal  the  approach  of  this 
"spell."  He  will  become  very  active  in  his  temperance 
efforts.     His   friends   realize  his   danger,  and   try  by  every 


CLIMATIC   PERIOD.  123 

means  to  help  him,  but  find  tliat  all  their  efforts  are  turned 
to  aid  him  in  concealing  it.  He  will  not  begin  unless  he 
can  find  some  way  to  conceal  his  presence  while  the  parox- 
ysm is  on  him.  When  his  friends  were  vigilant,  he  has  been 
kept  sober  for  a  week  or  more,  but  witii  the  first  opportu- 
nity he  disappears,  and  all  tiieir  work  has  been  thwarted  by 
his  cunning.  In  another  case,  the  most  deliberate  reason- 
ing and  planning  will  mark  the  paroxysm.  In  another 
case,  all  at  once  he  will  rush  away  and  diink  in  the  most 
suicidal  and  insane  way,  only  giving  as  an  excuse  some  real 
or  fancied  injury  or  trouble.  This  deliberation  and  cunning 
is  a  symptom  of  mental  unsoundness,  and  is  most  obviously 
reasoning  insanity,  and  will  be  recognized  when  these  cases 
are  better  understood.  Dipsomaniac  and  periodical  inebri- 
ety very  soon  became  reasoning  maniacs,  dangerous  bC' 
cause  they  are  unknown  and  misunderstood. 

In  a  study  of  social  statistics,  nativity^  sex,  age,  tempera^ 
ment^  climate,  occupation,  custom,  and  social  conditions,  are  import- 
ant factors  in  the  etiology  of  alcoholic  inebriety,  outside  ot 
the  well-known  causes  preceding  or  accompanying  dis- 
ease or  injury  and  heredity,  and  also,  to  a  certain  extent, 
are  to  be  taken  into  consideration  in  the  treatment  of  all 
cases  of  inebriety. 

Nativity  of  tiie  4,663  cases  under  care  at  Fort  Hamilton, 
N.  Y.,  was  as  follows  :  United  States,  3,186  ;  Ireland,  826  ; 
England,  203  ;  Scotland,  77  ;  British  Possessions,  73  ;  Ger- 
many, 109;  other  nationalities,  44  ;  not  recorded,  145.  The 
United  States  naturally  compose  a  large  majority,  as  we 
find  in  asylums  of  other  countries  inhabitants  of  those 
countries  as  inmates  will  be  in  excess  of  all  others  ;  but 
we  must  acknowledge  that  the  nervo-sanguine  tempera- 
ment of  the  American  is  peculiarly  susceptible  to  the  evil 
effects  of  alcohol,  and  that,  other  things  being  equal,  the 
average  American  would  sooner  succumb  to  inebriety  than 
his  transatlantic  brother.  Ireland  takes  the  lead  among 
foreign    nationalities.       Next   in  order    we    have    England, 


124  DISEASES    OF   INEBRIETY. 

Germany,  and  Scotland  ;  tlie  lesser  nationalities  occur  in  in- 
significant proportions,  and  do  not  call  for  special  comment. 

As  a  matter  of  racial  importance  I  cannot  recall  a  single 
instance  of  acute  or  chronic  alcoholic  mania  in  the  negro 
among  the  several  thousand  inebriates  who  have  passed 
under  my  notice  during  a  period  of  nearly  twenty-four 
years. 

In  reply  to  a  series  of  questions,  Dr.  Edwards,  of  Rich- 
mond, informs  me  "  that  the  negro  is  rarely  the  subject  of 
chronic  mental  or  nervous  disease  arising  from  alcohol, 
although  it  is  rare  to  find  a  negro,  male  or  female,  who 
does  not  drink.  Alcoholic  liquors  are  preferred,  and  yet 
the  laboring  negro,  as  a  rule,  is  not  a  drunkard."  He 
attributes  this  to  the  out-door  life,  simple  habits,  and  low 
grade  of  nervous  organization  of  the  negro. 

Climate. — As  to  the  influence  of  climate  on  inebriety, 
we  have  not  any  special  statistics  to  show,  but  it  is  a  popu- 
lar impression  that  the  inhabitants  of  low  levels,  especially 
near  the  sea-coast,  are  more  apt  to  be  intemperate  tlian  the 
dwellers  on  the  higher  plateaus,  table-lands,  and  mountain- 
ous districts.  The  influence  of  certain  barometric  condi- 
tions, dependent  upon  atmospheric  changes,  in  influencing 
and  producing  certain  conditions  of  the  nervous  system,  is 
familiar  to  all  who  have  made  this  subject  a  special  study. 
It  is  also  a  well-known  fact  that  in  malarious  districts  the 
depressing  effects  of  the  malarial  cachexia  are  counteracted 
by  the  free,  habitual  use  of  quinine,  strychnine,  coffee,  and 
other  nerve  stimulants,  among  which  alcohol  predominates. 
No  one  will  dispute  the  fact  that  an  unhealthy,  enervating 
climate  is  more  apt  to  produce  intemperance  and  conse- 
quent inebriety,  than  a  climate  having  just  the  opposite 
characteristics.  Climate,  undoubtedly,  is  one  of  the  factors 
in  the  production  of  inebriety,  as  it  is  of  other  diseases. 

Sex. — There  were  4,084  males  and  579  females.  The 
Fort  Hamilton  Asylum  is  intended  more  especially  for 
males,  hence   the  small   proportion   of   females.     It  has  no 


CLIMATIC   PEKIOD.  125 

provision  for  females  of  the  better  class  ;  the  female 
inmates  were  from  the  middle  and  lower  classes  of  society, 
but  the  inference  must  not  be  drawn  that  inebriety  does 
not  prevail  among  females  of  all  classes,  or  that  the  above 
is  a  fair  relative  proportion  of  the  inebriates  of  botli  sexes. 
In  this  countiy,  undoubtedly,  the  male  inebriate  far  exceeds 
in  numbers  female  inebriates.  But  this  is  not  universally 
the  case.  In  England  and  Wales  the  habitual  inebriate 
females  already  convicted  to  the  habitual  inebriate  males 
already  convicted  are  as  three  to  one.  In  England,  espe- 
cially among  the  higher  classes  of  society,  inebriety  pre- 
vails to  a  greater  extent  among  females  than  in  the  same 
class  and  sex  in  the  United  States. 

Social  Conditions. — The  married  male  inebriate  exceeds 
in  numbers  the  unmarried  male  inebriate.  There  were  2,098 
married,  1,744  single,  male  inebriates  ;  and  especially  does 
the  married  female  inebriate  in  far  greater  proportion 
exceed  the  unmarried  female  inebriate.  There  were  401  mar- 
ried female  inebriates  and  only  48  single  female  inebriates. 
Must  we  conclude  that,  other  things  being  equal,  the  married 
life  predisposes  to  inebriety  >  It  would  seem  so,  in  the  case  of 
females  at  least.  The  married  female  has  a  much  greater 
strain  upon  both  her  mental  and  physical  constitution  than 
the  unmarried.  A  fact  substantiated  in  the  reports  of  our 
Asylum  further  shows,  that  unmarried  males  are  more  fre- 
quently subjects  for  re-admission  than  the  married  ;  that  is, 
that  they  are  more  apt  to  relapse.  The  reverse  is  true  in 
regard  to  females.  Married  females  are  more  apt  to  relapse 
than  unmarried  females.  The  latter  are  not  apt  to  relapse  ; 
if  they  do,  it  is  the  exception  to  the  rule.  The  spinster 
then,  is  the  most  temperate  member  of  society.  There  were 
242  widowers  and  130  widows  also  recorded. 

Approximation  of  Ages. — The  ages  of  the  majority  of  the 
cases  treated  were  from  20  to  60,  the  greater  proportion 
from  30  to  50,  and  of  these  considerably  over  one-half  were 
between  30  and  40  years  of  age.     Below  the  age  of  20  and 


126  DISEASES   OF   INEBRIETY. 

above  the  age  of  60,  comparatively  few.  The  oldest  patient 
w^as  73  years  of  age,  and  the  youngest  18  years.  We  must 
conclude  that  the  great  majority  are  of  that  period  of  life 
which  is  the  most  effective  for  usefulness  and  attainment 
under  normal  conditions.  In  other  words,  alcohol  cripples 
and  handicaps  the  majority  of  inebriates  at  the  most  useful 
period  of  life.  Another  fact  is,  that  inebriates  may  excep- 
tionally, but  do  not  as  a  rule,  attain  to  a  long  life.  About 
one  in  385  of  inebriates,  whom  we  treated,  reached  the  age 
of  70  years. 

Occupatio7t. — Let  us  now  consider  the  relation  of  in- 
ebriety to  occupation.  Imagine  a  community  of  4,663  adult 
inebriates,  embracing  every  trade,  employment  or  profes- 
sion. Excluding  234  males  who  had  no  occupation  and 
562  females,  275  of  whom  were  unemployed,  and  the 
balance  either  domestics  or  housekeepers,  we  liave  about 
3,867  males  who  were  variously  occupied,  representing 
two  hundred  trades,  professions,  commercial,  mercantile,  or 
agricultural  occupations. 

We  find  directly  engaged  in  the  liqtior  business  71  bar- 
tenders and  51  liquor  dealers.  The  indoor  trades  exceeded 
the  outdoor  trades.  Among  those  engaged  in  the  outdoor 
occupations,  inebriety  seemed  to  affect  most  those  whose 
business  especially  exposed  them  to  irregular  hours  and 
inclement  weather, — teamsters,  cartmen,  coachmen,  carmen, 
conductors,  drivers.  One  hundred  such  are  recorded.  Tiie 
next  in  frequency  were  butchers  (45)  ;  next  stone-cutters 
(28)  ;  next  plasterers  (26)  ;  next  coopers  (19).  The  other 
occupations  being  at  or  below  the  latter  figure,  and  run- 
ning at  or  about  the  same  average  or  percentage.  Among 
in-door  occupations  we  find  painters  (121)  in  the  majority. 
The  painter  handles  alcohol,  turpentine,  etc.  ;  his  occupa- 
tion is  not  a  healthful  one  ;  he  is  apt  to  contract  diseases 
incident  to  it,  as  turpentine  poisoning,  lead  colic,  and  ner- 
vous diseases  arising  from  lead  poisoning,  as  wrist  drop,  or 
paralysis  of  the  extensor  muscles,  etc. 


CLIMATIC    PERIOD.  127 

Next  in  order  come  printers  (58)  and  pressmen  (58). 
Long  hours,  extra  work,  night  work,  and  an  employment 
that  demands  great  rapidity,  and  probably  more  mental 
and  physical  strain  than  the  average  occupation,  may 
account  for  the  fact  that  the  printer  and  the  pressman  take 
the  second  place. 

The  other  trades  are  in  the  following  order  :  Shoemakers 
(45),  plumbers  (39),  tailors  (38),  hatters  (34),  tinsmiths  (31), 
waiters  (28),  photographers  (27),  carpet-weavers  (22),  glass- 
blowers  (21) — the  remainder  of  the  in-door  trades  were  at 
or  below  20, 

The  greater  part  of  the  various  occupations  were  from 
mercantile  or  commercial  life.  At  least  1,200  or  1,300,  or 
about  one-third  of  the  entire  number  belonging  to  one  or 
the  other  of  the  above  classes  in  the  following  order : 
Clerks  (565),  merchants  (283),  bookkeepers  (100),  salesmen 
(152),  agents  (78),  brokers  (44),  the  balance  being  made  up 
of  canvassers,  contractors,  railroad  officials,  bankers,  pub- 
lishers and  superintendents,  etc. 

In  agricultural  occupations  we  note,  farmers  (34),  and 
gardeners  (15). 

Professions. — Four  hundred  and  seventy-seven,  or  about 
one-eiglith  of  the  whole  number,  belonged  to  the  profes- 
sions, as  follows  :  Physicians  (115),  lawyers  (m),  engineers 
(58),  druggists  (43),  journalists  (39),  artists  ('32),  students 
(21),  reporters  (19),  clergymen  (10),  actors  (9),  the  balance 
being  in  small  proportion,  architects,  accountants,  actuaries, 
notaries  public,  chemists,  assayers,  army  officers,  dentists, 
editors,  etc. 

Why  physicians  are  in  excess  of  other  professions  is  due 
to  the  fact  that  they  lead  very  arduous  lives,  both  physical- 
ly and  mentally,  with  irregularity  as  to  sleep  and  diet,  rest 
and  recreation  ;  but  there  is  another  fact  also,  the  physician 
would  be  more  likely  to  appreciate  and  avail  himself  of 
asylum  privileges  for  the  treatment  of  his  inebriety  than 
any  of  the  professions. 


128  DISEASES   OF   INEBRIETY. 

In  considering  the  various  avocations  the  usual  average 
relation  of  the  occupation  or  profession  to  a  normal  con- 
dition of  society  must  be  considered.  In  this  way  only  can 
we  get  at  the  fact  as  to  wliether  any  one  calling  exceeds 
the  other  in  a  tendency  to  lead  to  inebriety. 

Results  of  Treatment,  etc. — Total  cases,  4,663  ;  still  under 
treatment,  1,283  I  total  cases  discharged  and  to  be  accounted 
for,  3,380  ;  doing  well,  1,465,  43  per  cent.  ;  lost  sight  of, 
662,  i9>^per  cent.  ;  unimproved,  555,  i63^  per  cent.  ;  re-ad- 
mitted, 556,  idYz  per  cent.  ;  died,  81,  2>^  per  cent.  ;  trans- 
ferred to  otiier  institutions,  61,  2  per  cent. 

Doing  well. — By  this  we  mean  the  patient  is  restored  to 
society,  to  his  business  and  social  relations.  Exclusive  of 
death  and  transfer,  the  percentage  will  be  nearer  45  per  cent. 
It  must  also  be  considered  that  the  inebriate  on  an  average 
is  not  brought  to  us  for  treatment  until  after  his  Inebriety  has 
existed  ten  years,  his  system  broken  down,  and  oftentime  the 
subject  of  incurable  disease,  the  result  of  his  inebriety  or 
some  disease  or  injury  with  which  his  inebriety  is  compli- 
cated, and  which  may  have  preceded  and  been  the  cause  of 
it.  Again,  not  only  do  inebriates  apply  at  a  late  period  for 
treatment,  but  onl}''  about  one-quarter  of  those  who  do 
apply  remain  over  six  months,  while  three-fourths  remain 
at  periods  varying  from  one  to  four  months,  and  the  large 
majority  less  than  the  legal  limit  of  three  months,  so  thai 
if  we  were  to  apply  the  same  rule  that  is  applied  to  other 
diseases  which  are  submitted  to  us  to  be  cured,  that  is,  hav- 
ing the  patient  brought  to  us  at  a  reasonable  period  after 
the  disease  tendency  has  manifested  itself,  and  having  also 
the  patient  remain  under  our  care  a  reasonable  length  of  time 
for  treatment  as  each  case  may  demand,  it  would  be  easy 
to  see  that  our  ratio  of  cures  would  be  75  or  80  per  cent., 
instead  of  43  per  cent,  as  they  now  are,  which  is  neverthe- 
less a  good  showing  considering  the  disadvantages  we  have 
had  to  contend  with.     We  are  confident  that  in  the  future, 


CLIMATIC    PEKIOD.  129 

under  proper  conditions,  at    least   three-fourtlis  of  the  in- 
ebriates treated  in  our  asylums  will  be  cured. 

Thirty-six  per  cent,  were  lost  sight  of,  or  unimproved,  but 
this  does  not  mean  they  will  not  be  heard  of  again  ;  a  cer- 
tain proportion  will  return  to  our  institution,  and  of  tliese  a 
number  will  be  cured.  Some  of  our  most  successful  cases 
are  those  wliich  have  been  in  the  asylum  at  different  periods 
under  treatment.  Of  the  balance,  some  will  die,  others  will 
move  away,  otiiers  go  to  similar  institutions  elsewhere 
located.  We  shall  not  make  any  comments  as  to  deaths 
except  to  call  attention  to  \.\\^  remarkably  small  percentage, 
which  is  about  equally  divided  between  those  who  died 
outside  of  the  asylum  and  those  who  died  in  the  asylum. 
Some  6i  were  transferred  to  other  insitutions — 30  to  the 
lunatic  asylum.  We  observe  the  tendency  of  inebriety 
toward  insanity.  The  great  majority  of  inebriates  caVry 
unevenly-balanced  minds  ;  they  are  on  the  verge  of  insanity 
all  the  time,  and  not  unfrequently  pass  over  the  line.  In 
any  inebriate  asylum  it  would  be  safe  to  assert  the  large 
majority  of  inebriates,  at  least  for  the  first  few  weeks  after 
their  entrance  into  the  asylum,  are  in  a  mental  condition 
that,  to  say  the  least,  is  not  normal.  The  above  30  trans- 
fers were  marked  cases  of  lunacy,  acute  or  chronic  mania, 
which  were  not  suitable  for  an  asylum  of  our  character. 
The  moral  effect  and  the  law  of  association  forbid  that  the 
inebriate  of  weakened  mind  and  body  should  be  associated 
with  insane  persons.  The  tendency  of  every  inebriate  is 
that  way,  and  such  association  would  only  precipitate  the 
event.  This  is  the  principal  argument  against  the  incarcera- 
tion of  insane  persons  and  inebriates  in  the  same  institu- 
tion, although  there  are  other  arguments  equally  effective, 
A  certain  proportion  of  persons  were  brought  to  the  asylum 
suffering  from  various  diseases  or  infirmities  that  rendered 
them  unfit  subiects  for  our  asylum.  Of  these,  some  31  were 
transferred  to  hospitals  or  other  institutions. 

We  have  thus  given  a  few  general  observations,  result- 


130  DISEASES    OF   INEBRIETY. 

ing  from  a  study  of  these  special  statistics.  We  have  not 
by  any  means  exhausted  tlie  subject,  but  we  trust  we  liave 
added  some  points  of  interest  and  importance,  not  only  to 
the  etiology  of  inebriety,  but  also  some  indications  for  its 
more  successful  treatment. 


CHAPTER  XV. 

ALCOHOLIC    DELIRIUM     AND     ASSOCIATED    CONDITIONS. 

The  existence  of  certain  specially  dangerous  and  hyper- 
acute forms  of  delirium  tremens  has  been  known  and  recog- 
nized by  many  writers  since  the  days  of  Magnus  Huss,  but 
the  first  distinct  description  of  this  class  of  cases  in  which 
an  attempt  at  their  differentiation  from  the  ordinary  type 
was  made,  seems  to  have  been  that  of  Delasiauve,  of  his 
so-called  superacute  form  in  1852.  In  his  cases,  however,  the 
distinctive  symptom  of  fever  was  absent,  and  it  was  left  for 
Magnan,  in  1873  and  1874,  to  describe  as  a  distinct  variety, 
his  cases  of  febrile  delirium  tremens. 

Although  the  cases  which  I  am  about  to  report  do  not 
agree  in  all  respects  with  those  related  by  him,  I  have  ven- 
tured to  make  use  of  the  title  of  febrile  delirium  tremens 
for  them  also.  One  of  the  predominant  symptoms,  perhaps 
we  may  even  say  their  most  striking  cliaracteristic,  was  the 
presence  of  fever,  and  in  many  points  they  closely  resemble 
the  cases  of  Magnan.  Moreover,  there  can  be  little  doubt 
that  the  different  varieties  of  delirium  tremens  shade  imper- 
ceptibly into  each  other  and  that  they  are  all  acute  mani- 
festations of  chronic  alcoholism  modified  in  their  symptoms 
by  the  constitution  of  the  patient,  his  condition  at  the  time, 
the  existing  complications  and  various  other  attending  cir- 
cumstances. 

The  presence,  however,  of  so  important  a  symptom  as 
fever,  affords,  in  our  opinion,  a  sufficient  ground  for  placing 
those  cases  in  which  it  exists  to  any  marked  degree,  in  a 
separate  category  from  the    ordinary  simple  febrile  cases. 

131 


132  DISEASES    OF   INEBRIETY. 

Since,  after  as  thorough  an  examination  as  possible  of  tlie 
voluminous  literature  of  delirium  tremens,  we  have  found 
no  carefully  reported  cases  of  this  character,  since  those  of 
Magnan,  we  feel  justified  in  bringing  these  to  tlie  notice  of 
tlie  profession  more  especially  as  we  believe  tliat  there  are 
certain  considerations  connected  with  them  of  considerable 
importance  both  to  the  specialist  and  perhaps  even  more  to 
the  general  practitioner. 

A  full  description  of  the  case  is  given,  of  which  the  fol- 
lowing is  a  summary  : 

In  this  case  we  have  a  man  of  thirty-two,  with  a  distinct 
predisposition  to  mental  disease,  and  addicted  for  a  consid- 
erable period  to  the  excessive  use  of  alcohol.  Having  con- 
tinued the  abuse  of  the  stimulant  after,  at  least,  two  attacks 
of  delirium  tremens,  he  finally,  four  weeks  before  entering 
the  hospital,  and  probably  much  earlier,  is  perceived  to  act 
in  a  strange  manner,  to  have  temporary  lapses  of  memory, 
and  hallucinations  of  sight  and  hearing.  On  entrance,  he  is 
found  to  be  much  in  the  condition  of  a  patient  recovering 
from  a  severe  attack  of  delirium  tremens — weak,  with 
decided  tremor  of  face  and  hands,  and  mentally  affected, 
unable  to  realize  his  surroundings.  Very  shortly ,  /ever  was 
detected,  and,  instead  of  improving,  he  grew  rapidly  worse. 
The  general  weakness  increased,  and  was  accompanied  by 
v-ery  marked  and  constant  subsultus  tendinum,  and  by  con- 
tinual plucking  at  the  bed-clothes.  The  tongue  was  cracked, 
dry,  and  parched,  and  the  general  condition  suggested  that 
of  typhoid  fever.  Mentally,  he  likewise  became  worse,  hav- 
ing constant,  rapidly  changing  hallucinations,  many  of  them 
terrifying  and  horrible,  but  many  also,  and  the  proportion 
of  these  increased  as  the  disease  progressed,  of  a  not  unpleas- 
ant character.  He  constantly  imagined  that  he  saw  friends 
and  acquaintances,  who  spoke  and  chatted  with  him.  He 
talked  aloud  much  of  the  time,  often  starting  up  suddenly 
and  answering  some  subjective  question.  This  condition  of 
things  continued   for  a   montli,  being  varied   by  periods  of 


ALCOHOLIC   DELIRIUM.  133 

semi-coma,  when  he  could  with  difficulty  be  roused  to 
answer  questions.  The  fever  ceased  at  one  time,  to  recur 
later.  At  the  end  of  a  month  his  strength  had  improved, 
and  there  were  no  acute  symptoms  remaining.  From  this 
time  his  mental  condition  improved  until  he  left  the  hospital, 
only  to  grow  worse  afterwards,  and  to  necessitate  a  still 
longer  treatment  before  final  recovery. 

In  this  case,  there  is  little  doubt  that  there  existed  in  the 
beginning  that  condition  of  chronic  alcoholic  poisoning  so 
carefully  described  by  Lentz,  under  the  title  of  chronic 
hallucinatory  alcoholism.  This,  possibly  due  to  the  with- 
drawal of  stimulants,  passed  soon  into  an  acute  febrile  con- 
dition, recurrent,  and  lasting  about  a  month,  to  be  followed 
in  its  turn  by  the  ordinary  hallucinatory  alcoholic  insanity. 

The  second  case  was  that  of  a  liquor-dealer,  thirty-two 
years  of  age,  a  native  and  resident  of  Boston. 

One  of  the  patient's  uncles  was  insane  for  a  time,  and  at 
the  Worcester  Asylum  for  six  months.  No  record  of  any 
other  mental  or  nervous  affection  in  the  family  obtained. 

Patient  had  been  healthy,  except  as  follows  :  He  has 
been  a  constant  drinker  for  two  or  three  years,  and  at  times 
has  drunk  very  heavily.  Last  autumn,  he  had  several  epi- 
leptic fits,  and  he  has  fallen  down  stairs  several  times.  Two 
weeks  before  entrance,  he  stopped  the  use  of  alcohol 
entirely  for  five  days,  but  then  resumed.  He  was  at  this 
time  placed  under  the  care  of  a  physician,  as  he  had  begun 
to  have  hallucinations  of  sight,  and  was  rapidly  growing 
worse.  Finally,  being  inclined  to  be  violent,  he  was  brought 
to  the  hospital. 

This  case  was  similar  to  the  others. 

In  both  the  preceding  cases  we  have  to  deal  with  patients 
in  whom,  we  may  presume,  a  certain  tendency  to  mental 
disease  exists.  One  had  already  himself  been  in  an  asylum; 
the  other  had  had  a  near  relative  in  one.  In  both,  the 
existing  affection  was  undoubtedly  induced  by  addiction  to 
the  excessive  use  of  alcohol.     The   more  prominent  and 


134  DISEASES    OF    INEBKIETY. 

noteworthy  symptoms  in  these  cases  may  be  resumed  as 
follows  :  (i)  Tlie  duration  of  the  disease,  followed  in  both 
cases  by  recovery,  in  connection  with  (2)  the  peculiar  tem- 
perature, rising  at  times  to  102^  or  more  ;  (3)  the  great 
weakness  of  the  patient,  especially  in  the  earlier  stages  ; 
(4)  the  typhoidal  appearance  ;  (5)  the  constant  subsultus 
tendinum,  and  the  plucking  at  the  bed-clothes  ;  and  (6) 
which  is  less  uncommon,  the  long  duration  of  the  pecu- 
liar form  of  delirium  vvh'ich  in  the  beginning,  precisely 
resembled  that  of  delirium  tremens,  but  continued  for 
weeks,  with  a  gradual  change  to  less  terrifying  hallucin- 
ations. 

I  will  not  enter  here  into  the  question  of  the  differentiation 
of  these  cases  from  typhoid  fever  and  other  diseases,  but 
will  merely  say  that  in  the  cases  related  tliere  did  not  exist 
any  of  the  more  diagnostic  symptoms  generally  seen  in 
typhoid  fever,  except  the  general  typhoid-like  condition  of 
the  patient,  and  that  in  both  cases  the  course  of  tlie  temper- 
ature was  unlike  that  usual  in  typhoid. 

The  medico-legal  importance  of  such  cases  as  these 
seems  to  me  considerable.  The  question  to  decide  is 
whether  the  patients  were  actually  insane,  and  likely  to 
remain  so  for  a  considerable  period  of  time,  or  whether  the 
condition  was  a  more  or  less  temporary  one,  and  the  patient 
had  a  fair  chance  of  recovery.  In  the  first  case,  the  actual 
question  to  be  decided  was  whether  the  patient  should  at 
once  be  committed  to  an  asylum,  or  whether  it  weie  advis- 
able to  wait  ;  in  the  second,  whether  the  patient  was  likely 
to  remain  in  his  actual  condition  so  long  that  it  was  right 
and  advisable  that  his  property  should  be  put  in  trust.  In 
both  cases  the  decision  was  in  the  negative,  and  rightly  so. 

I  cannot  help  feeling,  for  these  reasons,  that  it  is  very 
important  that  this  class  of  cases  should  be  early  recognized, 
not  only  by  specialists,  many  of  whom  have,  undoubtedly, 
opportunities  for  observing  them  more  or  less  often,  but 
also  by  the  general  practitioner,  into  whose  hands  they,  in 


ALCOHOLIC    DKLIEIUM.  135 

the  beginning,  almost  always  fall.  All  the  cases  of  this 
character  that  I  have  seen,  or  have  been  able  to  find  accounts 
of  up  to  the  present  time,  have  either  been  fatal  within  a  few 
days,  or  have  ended  in  recovery.  At  any  rate,  if  death  does 
not  occur  within  ten  days,  the  prognosis  is  more  favorable 
than  one  would  be  led  to  suppose  by  simple  consideration 
of  the  duration  and  character  of  the  symptoms. 

In  regard  to  the  pathology  of  these  cases,  although 
data  sufficient  to  justify  a  decided  opinion  are  wanting, 
certain  facts  bearing  on  this  subject  may  be  mentioned. 
Without  entering  into  detail  in  regard  to  the  pathological 
changes  of  the  nervous  centers  and  their  envelopes  in 
alcoholism,  we  may  refer  to  a  few  general  results.  Four- 
nier  states  that  autopsies  after  aaite  alcoholism  in  man  show 
most  commonly  the  following  lesions:  "  cerebral  conges- 
tion, more  or  less  intense  ;  meninges  injected,  veins  and 
vessels  of  the  pia  mater  gorged  with  blood,  cerebral  sub- 
stance dotted  with  points,  roughened  (sable),  and,  on 
section,  permitting  the  escape  of  fine  drops  of  blood  ; 
sometimes,  also  effusion  of  serum  into  the  meninges." 

In  chronic  alcoholism  we  find  two  classes  of  lesions  in 
these  organs  ;  the  one,  which  may  fairly  be  classed  as 
acute,  though  the  result  of  clironic  changes,  comprising, 
for  example,  hemorrhages,  and  perhaps  some  effusions  ; 
the  other  class,  the  subacute  and  chronic.  Audhoui,  writ- 
ing in  1868,  says  :  "There  is  no  need,  I  think,  of  insisting 
on  the  form  that  the  nutritive  trouble  affects  in  the  nervous 
centers,  thickening  of  the  meninges,  the  production  of  false 
membranes  on  the  cranial  dura  mater,  adherence  of  the 
pia  mater  to  the  cerebral  cortex,  hypergenesis  of  the 
neuroglia,  fatty  degeneration  of  the  nerve-cells,  of  the 
capillaries,  etc.  ;  all  this  is  perfectly  well-known." 

In  regard  to  tlie  superacute  form  of  delirium  tremens  we 
may  mention  two  varieties,  the  "  forme  suraigne  "  of  Dela- 
siauve,  and  the  delirium  tremens  febrile  of  Magnan. 

Delasiauve's  form  is  described  by  Lentz  as  follows  ; 


136  DISEASES    OF   INEBKTETY. 

*'  The  forme  suraigne  of  Delasiauve  is  remarkable  par- 
ticularly for  its  violence,  its  agitation,  the  intensity  of  the 
delirium  and  the  gravity  of  the  general  condition.  The 
nervous  activity  is  prodigious  ;  the  patient  has  neither 
respite  nor  repose,  no  part  of  his  body  is  free  from  move- 
ment ;  liis  face  bloated,  red,  even  violet,  is  contorted  through 
the  quivering  of  the  muscles  ;  his  eyes  roll  in  their  orbits  ; 
his  skin  is  hot  and  burning,  is  moist  with  a  profuse  and 
sticky  sweat,  whicli  sometimes  emits  an  alcoholic  odor. 
The  tongue  may  preserve  its  natural  moistness  ;  more  often 
it  is  dry  along  the  edges,  and  its  surface  as  well  as  the  edges 
are  covered  with  fuliginous  crusts.  Usually  the  thirst  is 
excessive,  unquenchable ;  the  respiration  more  or  less 
labored  ;  the  alteration  of  the  features  indicates  a  profound 
prostration.  As  to  the  pulse,  sometimes  rapid  and  feeble, 
at  other  times  it  contrasts  by  its  almost  normal  rhythm 
with  the  other  symptoms.  The  mind  is  assailed  by  hallu- 
cinations whose  rapid  succession  causes  an  incessant  change. 
The  words  crowd  each  other  so  in  the  patient's  mouth,  that 
several  demand  utterance  sim.ultaneously  and  escape  with 
difficulty  in  jerky,  interrupted,  often  unintellibible  sen- 
tences. In  constant  agitation  (jactitation),  the  head  and 
hands  are  moved  abruptly  in  all  directions  whejice  the 
imaginary  impressions  seem  to  arise." 

Magnan's  form  differs  but  little.  Its  principal  distinctive 
feature  is  the  rise  of  temperature  which  is  apt  to  run  high 
and  reach  40°  C.  {104''  F.),  or  even  42°  C.  (107.6°  F.).  This 
lasts  without  remission  for  two  or  three  days  or  perhaps 
longer,  and  if  not  followed,  as  is  usual,  by  a  fatal  result, 
gradually  descends  to  the  normal  limit.  This  form  also  is 
marked  by  the  constant  presence  of  muscular  movements, 
subsultus  tendinum,  jerkings  and  contractions  of  the  muscles 
all  over  the  body,  and  by  the  extreme  muscular  weakness 
which  eventually  results  from  this  incessant  activity.  Lentz 
considers  that  the  only  symptom  by  which  this  form  can  be 
differentiated  from   that   of  Delasiauve  is  the  possibility  of 


ALCOHOLIC    DELIEIUM.  137 

prolonged  remissions  in  which  the  consciousness  may  for  a 
time  become  quite  clear. 

The  presence  of  a  high  and  continued  fever  during  an 
attack  of  delirium  tremens,  is  always  a  symptom  of  most 
serious  import.  It  denotes  either  the  presence  of  some 
severe  and  dangerous  complication,  as  pneumonia  or  menin- 
gitis, or  it  implies,  as  is  thought  to  be  the  case  at  times,  by 
certain  authorities,  an  affection  of  the  cerebral  heat-centers, 
and  thereby  a  wide-spread  and  dangerous  condition  of  the 
cerebrum.  In  ordinary  cases  of  delirium  tremens,  there  is 
no  rise  of  temperature  whatsoever. 

Nacke  says  :  "  In  a  series  of  examinations  of  a  small 
number  of  cases  (eleven),  a  slight  feverishness  could  be  deter- 
mined in  one-third  of  them.  The  maximum  was  38.8°  C, 
loi^  F.  Any  temperature  above  this  pointed  to  some  inter- 
nal inflammation,  more  especially  pneumonia.  In  our  cases 
a  slight  fever  appeared  in  the  evening  only,  as  a  slight  rise 
of  the  physiological  evening  exacerbation  of  the  tempera- 
ture, never  in  the  prodromal  stage,  commonly  only  on  the 
first,  rarely  on  the  second  day  of  the  true  delirium.  Pulse 
and  respiration  were  commonly  only  slightly  increased  in 
rate." 

The  cause  of  the  fever  in  febrile  delirium  tremens  is  still 
doubtful.  Magnan  gives  the  results  of  five  autopsies  in 
which  little  definite  was  found  beyond  the  injection  and 
oedema  of  the  cerebral  meninges  and  a  similar  condition  of 
the  meninges  of  the  spinal  cord  with  injection  of  the  gray 
substance  of  the  latter.  He  himself  says,  that  besides  the 
hyperaemia,  which  sometimes  ends  in  hemorrhage  and  thus 
attests  the  very  violent  irritation  of  the  nervous  centers,  we 
scarcely  find  at  the  autopsy  anything  except  the  more  or 
less  advanced  alterations  of  ciironic  alcoholism. 

That  delirium  tremens  may  be  complicated  by  menin- 
gitis, is,  of  course,  well-known,  and  many  instances  have 
been  published,  of  which,  however,  I  will  only  refer  to  the 
cases  of  Bonnemaison. 


138  DISEASES    OF    INEBRIETY. 

Wliether  such  complication  exists  in  any  special  case, 
can,  of  course,  only  be  decided  after  a  careful  consideration 
of  all  the  symptoms. 

Whether  in  the  febrile  cases  ending  in  recovery,  the 
fever  is  due  to  complications  meningitic  or  otherwise,  or 
whether  it  is  simply  due  to  the  violence  of  the  cerebral 
irritation  and  the  affection  of  the  cerebral  heat-centers  has 
not  yet  been  proved.  The  evidence  in  favor  of  tlie  latter 
condition  is  up  to  the  present  time  wliolly  negative.  Con- 
sidering the  existence  of  heat-centers,  as  shown  by  Dr.  Ott 
and  others,  proved,  since  no  other  cause  of  the  liigli  tem- 
perature is  apparent,  and  since  cerebral  irritation  evidently 
exists,  it  is  assumed  that  the  fever  is  due  to  the  irritation  of 
these  centers.  It  must  be  remembered,  however,  that  this  is 
only  a  theory  with  some  plausibility  in  its  favor. 

Nacke  is  in  favor  of  this  view.  As  in  Magnan's  cases 
the  temperature  cannot  be  simply  dependent  on  increased 
muscular  action  "  since  now  at  the  autopsy  of  such  patients, 
beyond  the  more  or  less  marked  hyperaemia  of  the  central 
nervous  apparatus,  and  tlie  clianges  produced  in  the  system 
by  chronic  alcoholism,  notiiing  was  found  which  could 
explain  the  violent  fever,  we  must  in  tliese  cases  regard  tlie 
fever  as  directl}'  dependent  on  the  action  of  the  lately  intro- 
duced masses  of  alcohol  upon  the  heat  regulators." 

We,  however,  do  not  believe  that  this  question  can  yet 
be  decided  without  further  evidence. 

Anotlier  form  of  delirium  tremens  has  been  noticed  as 
coming  from  traumatism. 

This  nervous  affection,  characterized  by  muscular  tremor 
and  a  peculiar  restless  delirium,  not  infrequently  follows 
the  receipt  of  injuries  in  those  accustomed  to  alcoholic 
stimulation. 

Some  writers  describe,  under  the  terms  traumatic  delir- 
ium and  nervous  delirium,  a  condition  frequently  very 
similar  to  delirium  tremens,  wliich  is  said  to  occur  in 
patients  free  from  the  alcohol  habit,  and  to  depend  upon 


ALCOHOLIC    DELIRIUM.  139 

nervous  prostration,  often  associated  with  shock  and  hem- 
orrhage. It  is  possible  that  failure  to  investigate  previous 
habits  with  judicial  acumen  has  allowed  to  arise  a  confusion 
between  delirium  dependent  simply  upon  traumatism  and 
delirium  induced  by  traumatism  in  alcohol  drinkers.  The 
muttering  delirium  and  muscular  twitching  that  supervene 
in  asthenia,  from  surgical  as  from  medical  causes,  and  the 
noisy  delirium  after  injury  that  is  exhibited  by  quick,  rapid, 
and  full  pulse,  and  by  febrile  reaction,  are  two  very  differ- 
ent conditions  to  which  the  name  traumatic  delirium  might 
with  propriety  be  applied.  These  forms  of  mental  disturb- 
ance, in  my  opinion,  better  called  asthenic  and  inflamma- 
tory delirium  respectively,  arise  without  reference  to  per- 
sonal habits. 

The  group  of  symptoms  which  I  propose  describing  as 
traumatic  delirium  tremens,  however,  is  found  especially,  if 
not  exclusively,  indeed,  in  those  whose  nervous  systems 
have  undergone,  prior  to  injury,  the  deterioration  due  to 
absorption  of  alcohol,  I  have  not  been  convinced  by  my 
experience,  nor  by  my  reading,  that  such  a  concatenation 
of  symptoms  can  occur  after  traumatism  in  the  absolutely 
abstemious.  The  amount  of  drinking  requisite  to  induce 
the  predisposition  vai'ies  with  the  individual.  The  repeated 
ingestion  of  quite  small  quantities  of  alcohol  may  give 
rise  to  the  delirious  susceptibility.  It  is  possible  that 
a  similar  deterioration  of  constitution,  and  a  consequent 
liability  to  trembling  delirium,  may  be  caused  by  the 
opium,  chloral,  and  tobacco  habits  ;  but  it  is  difficult  to 
differentiate  these  because  of  their  frequent  association 
with  alcoholic  excess. 

Traumatic  delirium  tremens  may  follow  even  slight  in- 
juries, but  compound  fractures  and  burns  seem  to  have  a 
special  tendency  to  develop  this  serious  complication.  Its 
occurrence  should  not  be  ascribed  to  the  restraint  imposed 
upon  the  patient's  habits  by  the  injury,  but  to  a  traumatic 
disturbance  of  a  previously  unstable  nervous  equilibrium. 


14:0  DISEASES    OF    INEBEIETY. 

Medical  authorities  vary  in  tlieir  appreciation  of  the  causa- 
tive influence  exerted  by  sudden  deprivation  of  accustomed 
stimulants  in  exciting  attacks  of  ordinary  delirium  tremens. 
It  is  probable,  however,  that  in  a  vast  majority  of  such 
cases  tlie  directly  exciting  causes  are  tlie  deficient  assimila- 
tion of  food,  the  anxiety,  and  the  nervous  strain  which  go 
hand  in  hand  with  a  period  of  debauch,  and  which  persist 
after  the  ingestion  of  alcohol  is  stopped.  Neither  is  the 
occurrence  of  the  malady  to  be  imputed  to  the  directly 
poisonous  effect  of  a  large  amount  of  consumed  alcohol, 
since  acute  alcohol  poisoning,  in  persons  unaccustomed  to 
the  use  of  alcoiiol,  gives  rise  to  stupor  and  death,  but  not  to 
delirium. 

Traumatic  delirium  tremens  occurs  because  chronic 
changes  in  the  nervous  tissue  or  blood,  or  perhaps  in  both, 
have  rendered  the  alcohol  drinker  susceptible  to  such  an 
outbreak  upon  the  application  of  any  disturbing  influence. 
The  receipt  of  injury  is  a  sufficient  perturbing  force,  especi- 
ally if  tlie  patient  be  on  the  verge  of  an  idiopathic  attack. 
It  has  been  thought  that  the  use  of  beverages  containing 
amylic  alcohol  (fusel  oil)  especially  predisposes  to  delirium 
tremens. 

The  alteration  in  nerve  structure  or  blood,  which  is  the 
essential  pathological  factor  of  delirium  tremens,  is  unknown 
to  us.  At  autopsies,  an  abnormal  amount  of  serum  is  usually 
found  in  the  substance,  and  within  the  ventricles  of  the 
brain  ;  meningeal  congestion  and  hemorrhage  are  often 
seen  ;  the  cells  of  the  gray  matter,  the  cerebral  connective 
tissue,  the  lymph  spaces  and  the  vessels  may  show  sclerotic 
or  fatty  changes  ;  and  the  liver,  kidneys,  and  digestive  tract 
may  exiiibit  the  characteristic  lesions  found  in  chronic 
alcoholism  ;  but  there  is  nothing  to  which  we  can  point  as 
the  distinctive  lesion  of  delirium  tremens. 

The  initiatory  symptoms  of  traumatic  delirium  tremens 
are  sleeplessness  at  night,  and  slight  tremor,  which  is  readily 
noticed  by  ordering  the  patient  to  hold  out  the  hand  with 


ALCOHOLIC   DELIRIUM.  141 

widely-separated  fingers.  Subsequently,  restlessness,  insom- 
nia, and  tremor  increase,  and  delirium  is. shown. 

The  delirium,  wliicli  is  often  first  exhibited  at  night,  is 
peculiar.  Tlie  patient  sees  numerous  small  animals  or 
insects  creeping  over  the  bed  and  about  liis  person,  or  is 
pursued  by  some  hideous  spectre.  Hence,  he  is  constantly 
endeavoring  to  eject  the  vermin  from  his  clothing,  or  trying 
to  escape  the  persecutions  of  his  tormentor.  I  have  now 
under  my  care  a  patient  with  traumatic  delirium  tremens, 
after  an  open  fracture  of  the  leg,  who  imagines  tliat  ele- 
phants are  moving  over  his  bed  and  tramping  on  his  legs. 
He  may,  in  his  efforts  to  get  rid  of  these  disgusting  and  dis- 
tressing annoyances,  leave  his  bed  and  fall  from  a  window 
or  down  a  flight  of  steps.  The  mental  condition  is  one  of 
depression,  trepidation,  and  great  activity.  He  is  exceed- 
ingly restless,  and  is  constantly  chattering  in  a  low  tone, 
but,  thougli  he  may  cry  out  because  of  fear,  he  shows  little 
or  no  maniacal  excitement.  He  is  good-natured,  not  prone 
to  violence,  and  can  often  be  aroused,  by  emphatically 
spoken  words,  to  an  understanding  of  his  surroundings: 
but  he  soon  relapses  into  the  previous  incessant  chattering 
and  motion.  Very  often  a  single  idea  recurs  again  and 
again  to  his  delirious  fancy,  and  not  infrequently  the  delirium 
has  a  comical  or  tragedo-comical  aspect.  The  muscular 
tremor  is  not  like  the  twitching  of  tendons  seen  in  asthenic 
conditions,  but  resembles  the  sliakiness,  from  want  of  coor- 
dination, seen  in  cerebro-spinal  sclerosis.  Often  there  is 
hurry  in  movement,  and  the  limbs  or  tongue  will  then  be 
thrust  forward  with  a  jerk.  The  tremor  of  delirium  tremens 
reminds  me  much  of  the  movements  that  would  be  expected 
in  an  association  of  chorea  with  sclerosis  of  the  nervous 
centres. 

During  these  symptoms,  the  patient  is  unable  to  sleep, 
is  incessantly  in  motion,  and  has  a  bright  eye  with  dilated 
pupils,  and  an  unsteady,  restless  look.  He  exhibits  a 
moist,  flabby,  tremulous  tongue  with  a  whitish  fur,  desires 


142  DISEASES    OP   INEBRIETY. 

no  food,  has  constipated  bowels,  and  passes  a  scanty,  high- 
colored  urine.  In  idiopathic  delirium  tremens  of  moderate 
severity  there  is  no  great  acceleration  of  tlie  pulse,  and  the 
temperature  does  not  rise  much  above  ioo°,  except  during 
active  muscular  exertion.  In  tliose  graver  cases,  vi'liich 
Magnan  calls  febrile  delirium  tremens,  the  bodily  heat  is 
apt  to  remain  in  the  neigliborhood  of  i02"-i25°,  though 
there  is  no  inter-current  affection  to  keep  up  the  temper- 
ature, and  the  pulse  rate  is  also  increased.  In  traumatic 
delirium  tremens  the  constitutional  disturbance,  due  to  the 
wound,  affects  the  pulse  and  temperature.  The  patient 
will  often  remove  the  dressings  from  his  wound,  or  subject 
the  injured  limb  to  violent  motion  without  appearing  to 
experience  pain. 

Traumatic  delirium  tremens  arises,  as  a  rule,  within  two 
or  three  days  after  the  receipt  of  injury,  and  lasts  usually 
not  more  than  five  or  six  days.  The  illusions  are  apt  to 
continue  during  the  night,  even  after  the  patient  has 
become  convalescent  and  quite  rational  in  the  daytime. 

The  peculiarity  of  the  tremor  and  delirium  renders  the 
diagnosis  easy.  If  my  view  of  its  causation  be  correct,  the 
existence  of  the  characteristic  symptoms  is  evidence  of 
previous  liabits  of  stimulation  ;  but  it  is  not  always  well  to 
mention  this  suspicion,  nor  to  call  the  disease  delirium 
tremens,  since  the  patient's  friends  may  be  unaware  of  the 
existence  of  such  habits. 

Death  may  occur  from  exhaustion,  coma,  or  some  inter- 
current affection,  and  is  sometimes  inexplicably  sudden. 
Tlie  character  of  the  traumatism  may  determine  the  mode  of 
death.  Pneumonia  is  frequently  associated  with  idiopathic 
delirium  tremens.  It  is  often,  in  fact,  the  exciting  cause  of 
the  delirious  outbreak,  and,  of  course,  in  traumatic  cases 
greatly  diminisiies  the  chances  of  recovery.  When  the  tem- 
perature shows  a  tendency  to  remain  high  without  a  suffic- 
ient traumatic  cause,  and  especially  when  the  tremor  affects 
all  the  muscles  of  the  trunk,  as  well  as  those  of  the  head  and 


ALCOHOLIC    DELIKIUM.  14:3 

extremities,  and  is  not  arrested  during  sleep,  the  prognosis 
is  bad.  A  history  of  previous  attacks  of  the  disease  renders 
the  outlook  more  grave. 

In  considering  treatment,  it  is  important  to  bear  in  mind 
that  delirium  tremens  is  an  asthenic  condition.  There  is 
action,  but  it  is  the  activity  of  weakness,  not  of  power. 
Depressants  are  therefore  injurious.  Five  or  ten  grains  of 
calomel,  or  one  or  two  seidlitz  powders,  may  be  administered 
in  the  beginning  of  the  disease,  or  when  its  occurrence  is 
feared,  because  of  the  anorexia  and  gastric  derangement. 
Concentrated  liquid  food,  bitter  tonics,  and  capsicum  add 
to  the  patient's  strength,  and  tend  to  give  tone  to  the  im- 
paired digestive  organs.  Bathing  and  mild  diuretics  may 
be  employed,  in  the  endeavor  to  eliminate  the  alcohol  that 
has  entered  the  system.  Ciiloral  hydrate  (gr.  x-xx)  with 
potassium  bromide  (gr.  xxx-xl)  should  be  given  every  two 
or  three  hours,  as  soon  as  sleeplessness  and  slight  tremor  are 
noticeable  ;  no  visitors  should  be  allowed  in  the  room. 
If  the  development  of  the  attack  is  not  prevented,  the  same 
treatment  is  continued,  but  the  doses  may  be  increased. 
The  object  is  to  quiet  the  nervous  system  and  induce  sleep. 
In  this  endeavor  an  occasional  dose  of  morphia  (gr.  1-4  to 
1-3,)  may  be  combined  with  the  chloral  and  potassium  bro- 
mide. The  excessive  use  of  opiates  is  undesirable,  for  it 
is  not  narcotism  that  is  desired,  but  sleep;  cerebral  conges- 
tion is  induced  by  overdosing  witli  morphia. 

If  fatty  heart  exists,  opiates  should  be  pushed,  perhaps 
rather  than  the  chloral  and  potassium  bromide.  Tiie  com- 
bination treatment  with  the  three  hypnotics  allows  the  sur- 
geon to  diminish  or  increase  each  element  according  to 
indications.  Tincture  of  digitalis  (m.  x-xxx)  every  two  or 
three  hours,  is  valuable  in  cases  of  weak  but  not  fatly 
heart,  where  there  is  pallor  and  cyanosis  with  probable 
anaemia  of  the  brain.  Strychnia  also  has  been  recom- 
mended in  delirium  tremens.  Meclianical  restraint,  with 
the  straps   and    the  straight  jacket,  is  only  to   be  adopted 


144  DISEASES    OF   INEBRIETY. 

when  efficient  watching  and  soothing  by  attendants  is 
impracticable.  All  such  apparatus  excites  the  patient  and 
is  very  liable  to  interfere  with  respiration.  The  best  appli- 
ance is  a  loose  but  strong  garment,  consisting  of  trowsers 
and  shirt,  in  one  piece,  with  loops  attached  for  fastening 
the  patient  in  bed.  Fractures  should  be  dressed  with 
plaster  of  Paris  bandages,  because  ordinary  splints  will 
probably  be  displaced  by  the  patient.  If  failure  of  vital 
powers  is  to  be  feared,  alcoholic  stimulants  in  small  amounts, 
administered  only  when  food  is  given,  are  judicious,  because 
in  chronic  drinkers  digestion  will  sometimes  not  go  on 
sufficiently  without  the  aid  of  alcohol.  Such  failure  of 
assimilation  in  delirium  tremens  may  turn  the  scale  against 
the  patient.  Whiskey  or  brandy  (F.  i§-F.  iv§  during  the 
twenty-four  hours)  in  the  form  of  milk  punch  or  egg-nog, 
is  probably  the  best  form  of  administration.  Many  pStients 
will  not  require  any  stimulants.  Vomiting  occurring  in 
delirium  tremens,  is  to  be  treated  by  milk  and  lime-water, 
cracked  ice,  effervescing  drinks,  bismuth  sub-nitrate,  pep- 
ain   and  carbolic  acid  mixtures. 


CHAPTER   XVI. 

GENERAL  FACTS    OF   HEREDITY  AND    PREDISPOSING  CON- 
DITIONS. 

Alcoholic  Heredity,  or  the  transmission  of  a  special  ten- 
dency to  use  spirits,  or  any  narcotic,  to  excess,  is  much 
more  common  than  is  supposed.  In  the  study  of  a  large 
number  of  cases,  several  distinct  groups  will  be  apparent. 

First  will  appear  the  direct  heredities.  Those  inebri- 
ates whose  parents  and  grandparents  used  spirits  to  excess. 
The  line  of  tiie  inheritance  will  be  from  father  to  daughter, 
and  motlier  to  son  ;  that  is,  if  tlie  father  is  a  drinking  man, 
the  daughter  will  inherit  his  disease  more  frequently  than 
the  son.  While  the  daughter  may  not,  from  absence  of 
some  special  exciting  causes,  be  an  inebriate,  her  sons  will 
in  a  large  proportion  of  cases  fall  from  the  most  insignificant 
exciting  causes.  About  one  in  every  three  cases  can  be 
traced  to  inebriate  ancestors.  Quite  a  large  proportion  of 
these  parents  are  moderate  or  only  occasional  excessive 
users  of  spirits.  If  the  father  is  a  moderate  drinker,  and 
the  mother  a  nervous,  consumptive  woman,  or  one  with  a 
weak,  nervous  organization,  inebriety  very  often  follows  in 
the  children.  If  both  parents  use  wine  or  beer  on  the  table 
continuously,  temperate,  sober  children  will  be  the  excep- 
tion to  the  rule.  If  the  motiier  uses  various  forms  of  alco- 
holic drinks,  as  medicines,  or  narcotic  drugs  for  real  or 
imaginary  purposes,  the  inebriety  of  the  children  is  very 
common.  Many  cases  have  been  noted  of  mothers  using 
wine,    beer,   or    some    form    of    alcoholic   drinks,   for   lung 


146  DISEASES    OF   INEBRIETY. 

trouble  or  other  affections,  and  the  children  born  during 
this  period  have  been  inebriates,  while  others  born  before 
and  after  this  drink  period  have  been  temperate. 

The  second  group  of  these  alcoholic  heredities  are  called 
the  indirect.  They  are  cases  wljere  the  inebriety  of  some 
ancestor  has  left  a  stream  of  diseases,  such  as  minor  forms 
of  insanity,  consumption,  and  various  nerve  defects,  whicii 
may  have  run  through  one  or  two  generations,  tlien  suddenly 
develop  into  inebriety,  with  or  without  any  special  exciting 
cause.  In  such  cases  the  moderate  or  excessive  drinking 
parents  will  be  followed  by  nervous  feeble-minded,  consump- 
tive, or  very  precocious  children,  or  eccentric  and  odd  people 
who  are  born  extremists  in  every  relation  of  life.  They  are 
persons  who  die  early,  and  leave  a  large  progeny,  who  suffer 
from  nerve  and  nutrient  troubles,  and  neuralgia,  and  find 
in  alcohol  and  opium  a  most  seductive  relief  from  all  their 
troubles.  About  one-fourth  of  all  cases  of  inebriety  are 
examples  of  this  form  of  indirect  heredity. 

A  third  group  of  heredities  in  these  cases  of  inebriety,  are  the 
complex  border-land  cases.  They  are  persons  whose  ancestors 
have  been  insane,  epileptic,  consumptives,  criminals,  pau- 
pers, and  had  other  forms  of  degeneration.  Victims  driven 
along  by  a  tide  of  degenerate  heredity,  which  burst  out  in 
varied  forms  and  phases  of  diseases.  This  class  are  seen 
among  the  very  wealthy  and  the  very  poor.  Fully  one- 
fourth  of  all  inebriates  are  of  this  class,  and  their  inebriety 
is  only  another  stage  of  profound  degeneration  in  the  march 
to  dissolution.  In  these  cases  there  seems  to  be  in  certain 
families  a  regular  cycle  of  degenerative  diseases.  Thus  in 
one  generation  great  eccentricity,  genius,  and  a  high  order 
of  emotional  development.  Extreme  religious  zeal,  or  un- 
reasonable skepticism,  pioneers  or  martyrs  for  an  idea,  and 
extremists  in  all  matters.  In  the  next  generation,  insanity, 
inebriety,  feeble-minded,  or  idiots.  In  the  third  generation, 
paupers,  criminals,  tramps,  epileptics,  idiots,  insanity,  con- 
sumption, and  inebriety.     In  the  fourth  generation,  they  die 


GENERAL  FACTS  OF  HEREDITY.  147 

out,  or  may  swing  back  to  great  genius,  pioneers,  and  heroes, 
or  leaders  of  extreme  movements. 

In  the  study  of  a  large  number  of  cases  of  inebriates,  a 
physical  and  mental  heredity  will  appear.  Thus  the  children 
of  inebriates  for  one  or  two  generations  will  be  found  to 
have,  as  a  rule,  physical  defects  and  deformities.  Bad 
shaped  heads  and  bodies,  an  inharmonious  development, 
retarded  or  excessive  growths,  club  feet,  cleft  palate,  defec- 
tive eyesight,  great  grossness  of  organization,  or  extreme 
frailty  of  development.  This  can  be  seen  in  the  observation 
of  almost  anyone,  and  indicates  the  defective  nutrition  and 
cell  growth  caused  by  injuries  from  alcohol  transmitted  to 
the  children.  The  mental  heredity  from  inebriate  parents 
is  equally  clear  and  apparent  to  any  close  observation. 
Mental  instability,  and  mental  feebleness  are  common  signs. 
Impulsive,  excitable,  emotional  persons,  who  are  on  the  two 
extremes,  either  buoyed  with  great  faith  and  hope,  or 
depressed  to  the  verge  of  despair.  Extravagant  self-esteem, 
boundless  faith  in  the  most  absurd  schemes  of  politics, 
religion,  and  science. 

Men  and  women  who  are  called  "  border-liners,"  mean- 
ing those  whose  good  judgment  and  reason  alternate  back 
and  forth  over  the  line  where  sanity  and  insanity  join. 
They  are  found  in  the  great  army  of  the  irregulars,  the 
intellectual  and  moral  quacks,  the  badly-balanced,  and 
weak,  unstable  mentality.  Genius  and  precocity  often 
appear  in  these  persons.  They  frequently  come  into 
prominence  like  blazing  comets,  dazzling  for  a  time,  then 
disappear  in  some  cloud  of  insanity,  inebriety,  or  other 
disease.  This  mental  heredity  will  be  often  seen  in  the  per- 
verted nutrient  tastes  of  children,  the  impulsive  appetites, 
and  dominant  animal  desires.  With  the  very  wealthy  and 
very  poor,  these  signs  of  alcoholic  heritage  are  prominent. 
One  of  the  reasons  is  the  excessive  nutrient  stimulation 
from   excess  of   quality  and   quantity  of  food,  among  the 


148  DISEASES    OF   INEBRIETY. 

wealthy,  and  the  opposite  among  the  poor  ;  also  the  under- 
work and  overwork  of  those  classes. 

These  are  only  hints  and  intimations  along  the  shore  of 
a  great  continent  of  facts,  which  some  future  explorer  will 
reveal.  It  will  be  of  interest  to  point  out  some  of  the 
results  which  follow  from  alcoholic  heredity.  First,  the 
longevity  is  di?ninished.  It  is  impossible  for  a  generation 
with' this  entailment  to  have  the  same  vigor  to  resist  disease 
and  death.  Exhaustive  physical  and  intellectual  exertion 
is  not  repaired  and  overcome  so  readily,  and  death  from 
slight  causes  are  more  common.  Thus  exposure  merges 
into  pneumonia,  and  other  fatal  conditions,  more  quickly 
than  in  others  without  this  entailment. 

In  epidemics  of  fevers  and  other  diseases  these  children 
of  alcoholic  parents,  and  inebriates  themselves,  die  first. 
The}^  die  from  injury,  shock,  strain,  worry,  and  care.  In 
brief,  this  alcoholic  legacy  from  ancestors  means  a  short- 
ened life,  an  early  death,  from  varied  insignificant  causes 
and  general  incapacity  to  bear  the  strains  and  drains  of 
the  ordinary  activities  of  life.  Second,  by  a  wise  limita- 
tion of  nature  the  race  with  this  heritage  must  die  out. 
Only  by  a  prudent  ingrafting  and  marriage  with  a  healthier 
stock  can  it  be  continued  into  the  future.  A  family  with 
this  heritage  is  on  the  road  to  extinction,  it  is  switched 
on  a  side  track,  and  is  moving  on  a  down-grade  of  rap- 
idly increasing  degeneration.  Nature  seems  to  often  make 
an  effort  to  put  on  the  brakes  and  check  the  speed  in 
some  remarkable  fecundity. 

Thus  in  these  degenerate  families  you  will  often  see 
a  great  number  of  children  who,  as  a  rule,  exhibit  many  of 
the  defects  of  the  parents,  and  are  short  lived. 

The  large  families  of  children  in  inebriate  parents  may 
be  taken  as  a  hint  of  the  approach  of  extinction  for  that 
race.  In  the  same  way,  great  genius  in  certain  directions, 
as  for  instance  a  poet,  an  orator,  an  inventor,  or  a  reformer, 
starting  far  away  above  the  levels  of  his  ancestors  and  sur- 


GENERAL  FACTS  OF  HEREDITY.  149 

roundings,  are  often  the  last  members  of  families  far  down 
towards  tlie  rapids  that  precede  the  final  plunge  into  obliv- 
ion, like  the  flicker  of  a  lamp  bursting  into  full  blaze  before 
extinction.  Third^  where  this  alcoholic  heredity  is  re- 
tarded or  accelerated  by  the  union  with  different  currents 
of  heredity,  very  strange  compounds  are  the  result.  Thus, 
if  to  this  alcoholic  heredity  are  united  a  heritage  of  insanity 
idiocy,  or  any  other  pronounced  defective  influence,  all 
grades  of  criminals,  paupers,  and  mixed  insanities  follow. 
While  most  of  these  defects  are  apparent  to  ordinary  obser- 
vation, yet  there  is  a  class  of  defectives  springing  from  tliis 
soil  which  may  be  termed  moral  paralytics,  which  will  be 
the  subject  of  bitter  controversy  in  psychological  circles  in 
the  near  future.  Along  this  frontier  line  the  great  questions 
of  free  will  and  moral  responsibility  must  be  settled.  The 
injury  from  alcohol  first  numbs,  then  finally  paralyzes  the 
higher  brain  forces,  which  includes  all  the  moral  elements. 
This  paralysis  goes  down  into  the  next  generation  as  a  con- 
genital deformity,  a  retarded  growth,  in  the  same  way  tliiit 
in  some  families  cross-eyes,  hare-lip,  defective  hands  or 
legs,  are  seen  in  every  generation.  This  form  of  heredity 
produces  criminals  of  tlie  most  dangerous  type  ;  men  and 
women  born  without  any  consciousness  of  duty,  of  right 
and  wrong,  of  obligation  to  live  a  moral,  consistent  life. 
From  these  mixed  heredities  some  central  brain  region  has 
become  malformed  and  degenerate,  and  tlie  victim  is  with- 
out power  to  change  or  comprehend  the  normal  relations 
of  mental  or  moral  life.  Many  of  these  persons  occupy 
places  of  wealth  and  influence  in  societ\\  holding  positions 
of  honor  and  respect,  by  force  of  surroundings  and  absence 
of  opportunity  to  reveal  their  incapacity  to  follow  lives  of 
truth  and  justice.     .     .     . 

If  this  subject  is  seen  liigher  up,  other  and  more  start- 
ling conclusions  appear.  First,  this  heredity  from  alco- 
hol is  intensijied  and  increased  by  the  misapplication  of  the 
educational  forces  of  to-day.     The  highest  culture  of  the  best 


150  DISEASES    OF   INEBKIETT. 

colleges,  applied  without  regard  to  the  natural  capacity  of 
the  individual,  and  along  unphysioiogical  lines,  must  clear- 
ly unfits  and  destroys  him.  Often  this  higiier  culture  is 
abnormal  stimulation  and  growth,  particularly  for  the 
entailments  of  past  generations. 

First  of  all,  the  educational  systems  do  not  alwciys 
build  up  healthy  brain  and  nerve  force.  Seco?id,  they  ignore 
all  heredity,  and  influences  of  food,  climate,  surround- 
ings, and  natural  capacity  and  the  result  is  that  abnor- 
mal impulses  are  intensified  in  certain  directions,  and 
the  power  of  control  is  diminished  in  a  positive  substratum 
of  exhaustion  from  which  chere  is  no  relief.  The  highest 
modern  culture  applied  indiscriminately  to  children  of 
inebriates,  will  result  in  tlieir  ruin  as  positively  as  any 
degree  of  ignorance.  This  is  seen  in  the  inordinate  self- 
esteem,  feeble  common  sense,  unstable  will  power,  extrava- 
gant idealities,  and  general  mental  dyspepsia  of  many  col- 
lege graduates.  In  actual  life  the  college  graduate  who 
has  an  alcoholic  heredity,  and  is  an  inebriate,  is  more  incur- 
able than  his  brother  who  has  never  had  a  college  culture. 
It  has  been  truly  said  that  ignorance  will  give  more  promise 
of  longevity,  and  a  final  triumph  over  this  heredity  than  the 
highest  indiscriminate  culture  of  to-day. 

Another  view  reveals  the  fact  that  the  present  legal  methods  to 
restrain  inebriety,  and  the  result  of  alcoholic  heredity,  pro- 
duce results  exactly  opposite.  Thus  the  army  of  inebriates 
and  irregulars  of  this  family  group  are  held  accountable  as 
healthy,  responsible  beings,  and  confined  in  most  dangerous 
mental  and  physical  surroundings,  actually  intensifying 
their  defects  and  removing  them  farther  from  all  hope  of 
recovery.  The  police  courts  and  jails  are  to  inebriates 
literal  training  stations,  for  mustering  in  armies  that  never 
desert  or  leave  the  ranks  until  crushed  out  forever.  A 
Chinese  law,  enacted  a  thousand  years  ago,  and  in  force 
to-day,  contains  a  flash  of  truth.  When  a  criminal  comes 
before  the  courts,  careful  inquiry  is  made  into  his  ancestry. 


GENERAL  FACTS  OF  HEREDITY.  151 

If  they  are  found  to  have  any  of  the  traits  common  to  the 
prisoner  he  is  killed  and  they  are  punished.  His  death  ends 
all  possibility  of  transmitted  crime,  and  their  punishment 
and  recorded  history  puts  a  clieck  on  any  farther  propaga- 
tion of  the  evil.  Common  law  and  public  opinion  are  far 
behind  the  march  of  science  in  a  practical  knowledge  of  this 
evil  and  the  means  to  correct  it.  Not  far  away  in  the  future 
this  terrible  shadow  will  vanish  before  a  larger,  clearer  intel- 
ligence, and  all  our  blind  efforts  of  to-day  will  be  found  to 
be  but  a  repetition  of  history — the  stage  of  empiricism, 
quackery,  and  superstition,  which  precedes  every  great 
advance  of  humanity.  From  a  highet'  ;point  of  view,  civiliza- 
tion and  the  increasing  complexities  and  changing  conditions 
increase  this  heritage.  Thus  every  new^  invention  which 
changes  the  direction  of  human  activities,  brings  greater 
strain  on  the  brain  and  nerve  force,  demanding  new  ener- 
gies, which  the  alcoholic  heredity  victim  cannot  give.  He 
is  unfitted  and  crippled  for  these  new  conditions  of  life  by 
his  forefathers, left  dismantled  and  without  strength  for  the 
race,  and  by  that  great  law  of  our  being  is  crushed  out, 
driven  out,  and  crowded  out  in  the  struggle  and  survival  of 
the  fittest. 

One  great  fact  comes  out  prominently  in  this  outline  re- 
view, namely,  that  alcoholic  heredity  or  a  predisposition  to 
inebriety,  and  many  other  nerve  and  brain  degenerations, 
will  certainly  follow  in  the  next  generation  from  the  moder- 
ate or  excessive  use  of  spirits.  Parents  who  do  not  recog- 
nize this  fact,  practicall}',  are  committing  unpardonable 
sins,  by  crippling  the  coming  generations  and  switching 
them  on  the  side-tracks,  away  from  the  main  line  of  devel- 
opment. 

Another  fact  appears  :  education  and  marriage  should 
be  governed  by  a  knowledge  of  heredity.  Education  should 
be  detemined  by  the  family  physician,  aud  have  for  its  ob- 
ject to  control  and  antagonize  all  the  predisposition  of  he- 
redity.    Marriage  sliould  be  under  control  of  law,  and  from 


152  DISEASES    OP   INEBRIETY. 

the  judgment  of  the  family  pliysician.  The  time  is  coming 
when  every  family  will  have  its  scientific  medical  advisers, 
and  these  vital  questions  of  heredity  and  practical  life  will 
be  determined  from  a  scientific  basis.  Still  another  fact 
comes  up  prominently.  The  great  armies  of  the  insane, 
inebriates,  criminals,  and  paupers  are  largely  the  doomed 
victims  of  the  sins  of  our  forefathers.  Our  duty  to  them  is 
to  house  them,  to  protect  them  from  perpetuating  their 
defects  and  injuring  others.  Science  tells  us  that  this 
army  of  hereditary  defectives  are  wards  of  the  State,  and 
should  be  housed,  quarantined,  made  self-supporting,  and 
forced  into  conditions  of  healthy  living.  The  present  indis- 
criminate freedom  of  this  class  is  a  sad  reflection  on  the 
intelligence  of  this  century.  The  study  of  alcohol  heredity 
furnislies  not  only  the  strongest  reasons  for  total  abstinence 
in  each  person,  but  reveals  the  laws  and  forces  which  gov- 
ern its  march  in  each  individual,  revealing  a  wider  range  of 
the  subject.  Along  this  line  of  heredity  will  be  found  the 
practical  solution  of  many  of  the  mysteries  and  remedie-s  of 
this  great  drink  problem. 

In  regard  to  the  transmissibility  of  inebriety  from 
parents  to  offspring  through  different  branches  and  gener- 
ations, and  its  correlation  with  insanity,  epilepsy,  and  other 
nervous  diseases,  there  is  far  less  known,  in  spite  of  all  that 
has  been  written  on  the  subject,  than  is  needed  to  be 
known.  It  is  not  the  disease,  it  is  the  tendency  to  the  dis- 
ease that  is  inherited  ;  and  this  tendency  is  not  transmitted 
to  all  the  children,  but  is  liable  to  be  transmitted  to  some 
of  them,  and  one  form  of  nervous  disease,  as  inebriety,  in 
one  or  both  parents,  may,  in  some  of  the  cliildren  or  more 
remote  descendants,  re-appear  as  epilepsy  or  insanity,  or 
hypochondriasis.  There  is  a  general  tendency  to  disease 
of  the  nervous  system  developed  and  fostered  under  our 
modern  civilization  and  institutions,  which  I  call  the  nervous 
diathesis,  and  which  subdivides  itself  into  various  phases  of 
nervous   disease,   such    as  neuralgia,  sick   headache,  spinal 


GENERAL  FACTS  OF  HEREDITY.  153 

and  cerebral  irritation,  hysteria,  and  hypochondriasis,  as 
the  hand  brandies  out  into  a  tiiumb  and  fingers. 

A  pliilosophic  study  of  the  transmissibility  of  inebriety 
requires  tliat  these  otlier  and  allied  disorders  be  studied  in 
connection  with  it,  and  studied  in  this  way  it  would  be 
proved  that  in  nearly  all  cases  of  inebriety,  as  in  nearly  all 
cases  of  other  and  allied  forms  of  nervous  disease,  there 
was  an  inheritance  of  the  nervous  diathesis  on  one  or 
on  both  sides,  and  usually  also  an  inheritance,  through  near 
and  remote  relatives  of  some  one  of  the  various  forms  of 
nervous  disease  that  spring  out  of  the  nervous  diathesis. 

A  similarly  thorough  investigation  of  nervous  diseases 
of  an  allied  character  would  show  if  not  as  marked,  yet  a 
very  decided  hereditary  tendency  in  them  all,  and  a  con- 
stant tendency  likewise  to  interchange,  reversion,  and  cor- 
relation of  the  different  manifestations  of  the  nervous 
diathesis.  Thus  hay  fever  in  a  parent  may  appear  as 
sick  headache  in  one  child,  as  epilepsy  in  another,  as 
insanity  in  another  ;  in  a  grandchild  as  inebriety,  in  a 
nephew  or  niece  as  simple  nervous  exhaustion. 


CHAPTER   XVII. 

FURTHER   CONSIDERATIONS   OF    HEREDITY. 

Alcohol  does  not  alone  affect  those  who  abuse  it,  but 
afflicts  more  or  less  grave  disorders  upon  their  children. 
Many  books  have  been  written  on  this  topic,  but  heredity 
in  nervous  diseases  resembles  so  closely  the  symptoms  of 
alcoholic  heredity,  that  the  latter  cannot  always  be  distin- 
guished. Another  cause  of  obscurity  is  owing  to  tiie  fact 
that  alcoholic  excess  does  not  necessarily  come  from  alco- 
holism, and  that  alcoholism  can  exist  apart  from  alcoholic 
excess.  Alcoholism  by  itself  in  the  ancestors  does  not  neces- 
sarily predicate  heredity  in  the  descendants.  This  requires 
a  whole  group  of  symptoms.  Many  families  in  which 
excess  have  happened  escape  alcoholism,  for  the  reason 
that  a  sufficient  number  of  predispositions  did  not  exist  to 
take  on  a  morbid  form. 

Historically,  alcoholic  heredity  was  known  since  the 
days  of  mythology.  We  are  told  that  Vulcan  lame  was 
conceived  by  Jupiter  drunk.  Diogenes,  addressing  a  stupid 
child,  said  :  "Thy  father  was  drunk  when  thy  mother  con- 
ceived thee."  Aristotle  declared  "  that  a  drunken  motlier 
would  produce  drunken  offspring."  The  legislation  of  Ly- 
curgus  promoted  drunkenness  in  vanquished  nations,  that 
it  might  extinguish  patriotism. 

The  Carthagenian  law  prohibited  any  drink  but  water 
on  the  day  of  cohabitation  with  one's  wife.  Numerous 
ancient  and  modern  authorities  have  repeatedly  called  atten- 
tion to  the  serious  and  varied  effects  of  parental  drunken- 


156  DISEASES    OF    INEBRIETY. 

ness  in  the  offspring.  The  first  serious  study  was  by  the 
celebrated  alienist  Morel.  He  first  defined  the  foundations 
of  alcoholic  heredity.  His  successors  have  done  no  more 
than  develop  what  he  had  discovered. 

There  are  admitted  to  be  two  general  forms  :  First,  the 
homologous  hereditary,  or  that  of  similitude.  Second, 
heredity  of  transformation,  or  eccentric  heredity.  In  the 
first  form  the  progenitor  gives  to  the  descendant  his  ten- 
den,  y  to  alcohol,  or  symptoms  of  his  alcoholism.  In  the 
second  form  the  alcoholized  mental  state  of  the  progenitor 
becomes  transformed  into  the  varied  nervous  disorders  of 
wiiich  the  body  may  develop.  No  alienist  of  to-day  denies 
this  direct  heredity.  The  examples  are  too  frequent  and 
striking;  but  it  must  be  remembered  that  heredity  will 
appear  under  the  most  varied  forms.  There  is  but  little 
agreement  among  authors  about  the  frequency  of  its  trans- 
mission. Dr.  Dodge  claims  that  fifty  per  cent,  of  all  inebri- 
ates were  hereditary.  Dr.  Bare  believes  that  twenty-five 
per  cent,  are  inherited.  Dr.  Kerr  thinks  over  fifty  percent. 
Dr.  Magnan  claims  eighty  per  cent.  Dr.  Parrish  eighty 
per  cent.  Dr.  Crothers  eighty  per  cent.  Dr.  Day  seventy 
per  cent.     Dr.  Mason  sixty  per  cent. 

The  mere  appetite  for  drink  transmitted  from  the  par- 
ent to  child  presents  so  many  varied  aspects  that  it  is  diffi- 
cult to  define  any  exact  law  for  its  manifestation.  It  is  not 
rare  to  see  it  reproduced  in  the  child  with  the  same  charac- 
teristics as  exhibited  in  the  parents.  As  a  general  law,  it 
may  be  stated  that  hereditary  alcoholism  begins  early,  aug- 
menting, reaching  its  climax,  and  showing  its  greatest 
activity  at  manhood  and  at  the  menopause.  Notwithstand- 
ing what  we  have  said,  heredity  does  not  always  reveal 
itself  by  this  disordered  appetite  for  drink. 

Heredity  not  unfrequently  shows  itself  by  irritability 
instability,  and  a  vicious  moral  disposition,  which  seems  to 
place  the  sufferer  under  some  burden  to  find  an  excitement 
which   will   relieve  him    from   his  suffering.      The   laws  of 


FUETHEK   CONSIDERATIONS    OF    HEREDITY.  157 

nerve  and  psycliopathic  heredity  govern  heredity  drunken- 
ness. For  this  reason  it  may  be  mediate  or  immediate, 
coming  direct  from  parents  or  skipping  several  generations 
in  their  descent. 

Apart  from  the  question  whetlier  strong  drink  produces 
alcoholism  or  alciiolism  produces  a  desire  for  strong  drink, 
it  is  certain  that  a  variety  of  mental  and  nervous  disorders 
engenders  a  desire  for  strong  drink.  Unfortunately  the 
control  of  these  cases  is  wholly  unknown  to  us.  Tiiis  con- 
stitutes the  first  variety  of  heredity  of  similitude,  which  is 
the  simple  transmission  of  the  defect  from  parent  to  child. 
A  second  variety  of  the  same  form  is  more  discussed.  This 
exhibits  in  the  descendant  symptoms  of  chronic  alcoholism 
witliout  any  accompanying  alcoholic  excess.  It  is  well 
ascertained  that  the  drinker  does  not  transmit  the  vice  of 
drinking,  but  tlie  disease  of  alcoholism.  Sensibility  is  di- 
minislied  in  their  descendants,  and  they  have  varied  and 
complex  symptoms  of  complex  nervous  disorder. 

The  author  cites  two  cases  of  the  homiietic  type,  in 
which  various  nervous  symptoms  were  present,  but  does  not 
deem  them  marked  typical  cases.  The  heterotype  form  is 
more  easily  defined.  Numerous  observations  render  it  cer- 
tain that  epilepsy  occurs  under  a  reflex  excitability  produced 
by  alcoholic  heredity.  The  same  mother  with  a  sober  man 
gives  birth  to  healtliy  children,  and  with  a  drunken  man  to 
epileptic  cliildren.  Statistics  prove  tlie  presence  of  epilepsy 
in  the  children  of  drinking  parents.  Of  eighty-tliree  epilep- 
tics, sixty  have  been  traced  to  drinking  parents.  Youthful 
convulsions  are  not  less  infrequent  than  epilepsy.  In  the 
families  of  sixty  alcoholics,  there  were  one  hnndred  and 
sixty-nine  survivors,  forty-eight  of  which  experienced  con- 
vulsions in  childhood.  In  the  case  of  twenty-three  non-al- 
coholic families,  having  seventy-nine  survivors,  only  ten  had 
convulsions  in  youth. 

Another  form  of  the  heterotype  order  is   seen  in  the  hys- 
teria and  sensitive    states  of    women.     In    men,  under    the 


158  DISEASES    OF    INEBRIETY. 

name  of  nervosisme,  it  offers  an  infinite  variety  of  symptoms. 
A  certain  number  of  tliese  nervous  symptoms  leave  no 
doubt  of  their  alcoliolic  origin.  The  digestive  function  is 
especially  the  seat  of  these  disorders,  prominent  of  wliicli  is 
nervous  dyspepsia,  vomiting,  hyperaesthesia,  insomnia, 
dreams,  enfeebled  muscular  force,  capricious  character,  and 
so  on. 

The  following  clinical  observations  make  this  class  more 
clear  :  A  laborer,  witii  alcoholic  father,  mother,  and  sister, 
died  of  lung  disease.  He  had  convulsions  in  youth,  is  neu- 
ralgic, has  headaches,  stomach  troubles,  and  is  weakly. 
His  character  is  unrestrained,  imperious,  and  he  has  fears  of 
becoming  insane.  He  drinks  but  little  wine,  because  it  dis- 
agrees with  him.  B,  a  woman  with  an  alcoholic  father. 
She  has  vomitings  every  few  days,  although  her  menses  are 
regular.  For  several  years  tliis  dyspepsia  is  more  pro- 
nounced at  the  menstrual  period.  Goes  often  without  eat- 
ing, and  has  cramps  of  the  stomach.  Laughs  and  cries,  and 
is  very  emotional  at  times.  Has  a  nervous  laugh,  and 
neuralgia  and  analgesia  all  over  the  body.  Sensibility  to 
heat  and  cold  is  gone,  and  the  sense  of  taste  and  smell 
greatly  diminished. 

These  cases  give  only  some  symptoms  of  the  varied  nerve 
troubles  which  follow  from  an  alcoholic  origin.  Tliese 
states  represent  a  continual  progression  from  a  simple  neuro- 
pathic temperament  to  the  most  pronounced  nervosisme. 
With  women  this  nervosity  is  revealed  by  more  or  less  pro- 
nounced symptoms  of  hysteria,  unaccompanied  by  convul- 
sive attacks.  A  third  manifestation  of  alcoholic  heredity  is 
impulsive  madness,  more  rare  than  others.  These  are  not 
explained  apart  from  hereditary  taint.  Often  it  is  the 
expression  of  an  extended  neuro-psychopathic  condition. 
The  moral  perversions  and  atrocious  crimes  often  seen  can 
only  be  accounted  for  by  the  alcoliolic  inheritance.  In 
addition  to  this  and  opposed  to  it  is  another  form  of  mania, 
consisting  of  a  delirious  obsession,  which  completely  con- 


FURTHER    CONSIDERATIONS    OF    HEREDITY.  159 

trols  the  idea  of  the  person,  despite  all  his  efforts  to  prevent 
it.  Its  approach  is  known  to  the  sufferer,  but  he  cannot 
deliver  himself  from  it.  It  has  only  recently  been  described, 
and  should  be  considered  a  consequence  of  alcoholic  ances- 
try. 

Krafft-Ebing  describes  two  cases  of  this  kind,  both  of 
which  had  alcoholized  fathers.  One  of  these  cases  was  a 
work-woman.  She  was  hysterical  from  youth  ;  once  had 
slight  loss  of  consciousness  ;  the  obsession  approached 
gradually  and  consisted  of  melancholy  and  religious  terror, 
with  perplexities  about  dogmas.  These  culminated  in  a 
conviction  to  abstain  from  all  food  and  drink.  From  simple 
mental  weakness  to  absolute  idiocy  there  are  grades  of 
degeneration  which  can  be  ascribed  to  hereditary  alcoholism. 
These  affections  may  be  congenital  and  primitive,  or  con- 
secutive, in  the  sense  that  the  slightest  cerebral  derange- 
ment will  result  in  irreparable  mental  weakness.  Lunier 
thinks  fifty  per  cent,  of  tiiose  who  exhibit  moral  imper- 
fections are  traceable  to  alcoholic  forefathers.  Beyond 
the  definite  cerebral  and  psychical  derangements  which  we 
are  acquainted  with,  there  are  many  moral  and  intellectual 
perversions  which  alcoholic  ancestry  fully  explains.  These 
persons  are  the  prey  of  moral  degeneration  inherited  direct 
from  their  parents.  From  youth  they  exhibit  the  worst 
instincts,  are  cruel,  vindictive,  and  quarrelsome.  Their 
delights  are  in  witnessing  suffering  and  tormenting  others. 
Later  they  are  lazy,  undisciplined,  and  vagabonds.  Usually 
it  is  impossible  or  very  difficult  to  educate  tliem,  and  the 
period  of  puberty  is  the  sign  for  throwing  off  all  restraint. 
Idleness,  indecision,  vagabondage,  moral  perversion,  rest- 
lessness, drink,  and  venereal  impulses  are  their  principal 
characteristics. 

These  persons  exhibit  a  wonderful  precocity  in  develop- 
ing the  drink  habit,  resulting  in  alcoholism  more  danger- 
ous from  the  fact  of  previous  disposition  to  degeneration. 
They  end  by  falling  into  the  instinctive  moral  manias,  the 


160  DISEASES    OF    INEBRIETY. 

existence  among  criminals,  which  has  been  so  much  dis- 
cussed. These  subjects  usually  pass  through  many  jails 
and  prisons  before  ending  in  asylums. 

Alcohol  is  even  worse  in  its  inflictions  on  the  physical 
nature  than  on  the  moral.  Children  of  alcoholized  parents 
are  nearly  always  timid,  feeble,  pale,  bad  nutrition,  and 
lessened  vitality,  making  them  an  easy  prey  to  attacks  of 
sickness.  The  muscular  sytem  is  but  little  developed,  and 
they  suffer  from  general  imperfect  growth  in  all  directions. 
One  of  the  consequences  of  alcoholic  heredity  is  the  partial 
and  unequal  development  of  the  brain,  amounting  to  gen- 
eral or  partial  atrophy,  unilateral,  and  accompanied  by 
cranial  malformations.  With  the  microcephalus  the  organic 
development  is  incomplete,  the  cranium  and  superior  region 
of  the  head  is  asymetrical,  the  body  hemiatrophical. 

Another  consequence  of  alcoholic  degeneration  is  hydro- 
cephalic, and  also  infantile  paralysis.  In  another  order  of 
observation  it  is  found  that  alcohol  heredity  diminishes 
fecundity  and  birth.  Lippich  has  demonstrated  that  alco- 
holized marriages  produce  two-tliirds  less  children  than 
among  those  who  were  temperate.  There  can  be  no  doubt 
that  alcoholism  affects  the  generative  function  of  both  sexes. 
The  testicles  undergo  degeneration  in  alcoholized  persons. 
The  spermatic  fluid  shows  this  in  the  well-marked  changes 
it  exhibits,  robbing  it  of  the  vitality  indispensable  to  con- 
ception. The  alcoholic  cachexia,  after  it  has  attained  suffi- 
cient intensity,  will  produce  this,  although  the  organs  may 
not  be  themselves  diseased. 

Many  examples  of  women  are  noted  who  have  had  chil- 
dren by  their  first  marriage,  whose  subsequent  union  was 
barren  with  an  alcoholized  husband,  and  also  the  reverse. 
Women  may  become  sterile  by  alterations  of  the  ovaries  and 
matrix,  and  abort  before  maturity.  From  this  point  of 
view  alcoholism  in  the  mother  is  a  more  serious  trouble 
than  in  the  father. 


CHAPTER  XVIII. 

STATISTICS  OF   HEREDITY  AND  OTHER  CONSIDERATIONS. 

Dr.  Matthews  gives  the  following  statistics  of  heredity  : 
"  The  passion  for  alcoholic  stimulants,  if  not  reproduced 
in  the  immediate  descendants,  may  show  itself  in  the  suc- 
cessive generations,  and  in  all  cases  is  the  most  prominent 
factor  in  insanity,  epilepsy,  idiocy,  hypochondria,  hysteria, 
neuralgia,  nervous  degeneration,  and  its  kindred  ailments — 
often  manifesting  these  maladies  in  a  vicious  circle — with 
the  effect  of  exhibiting  insanity  in  one,  epilepsy  in  another, 
intemperance  in  a  third,  idiocy  in  a  fourth,  hypoq^iondria 
in  a  fifth,  hysteria  in  a  sixth,  and  so  on  until  the  circle  is 
completed,  each  generation  increasing  in  numbers,  and 
contributing  in  a  direct  ratio  to  the  filling  of  our  jails,  pen- 
itentiaries, inebriate  asylums,  insane  retreats  and  poor- 
houses.  That  this  is  not  a  conjectural  statement  the  fol- 
lowing facts  will  abundantly  prove  :  In  a  Swedish  asylum 
it  was  found  that  50  per  cent,  of  the  patients  had  been 
addicted  to  the  use  of  alcoholic  beverages.  After  the 
removal  of  the  heavy  tax  on  alcoholic  drinks  in  Norway, 
the  percentage  of  increase  during  eleven  years  was  :  In 
mania,  41  per  cent.  ;  melancholia,  69  per  cent.  ;  dementia, 
25  per  cent.  ;  and  idiocy,  150  per  cent.  Of  the  last,  60  per 
cent,  were  the  children  of  drunken  fathers  and  mothers. 
In  the  insane  hospital  at  Vienna,  Austria,  probably  one  of 
the  largest  in  the  world,  the  superintendent  informed  me, 
personally,  that  from  50  to  60  per  cent,  of  the  insanity  was 
due  to  spirituous   liquors.     This    percentage   in   a   country 

161 


162  DISEASES    OF    INEBRIETY. 

where  it  is  claimed  alcoholic  drinks  do  no  harm,  is  well 
worth  noticing. 

In  our  own  State  insane  asylum,  of  the  now  present  in- 
mates, numbering  364,  75  per  cent,  can  be  ascribed  to  habits 
of  intoxication,  either  on  their  part  or  that  of  their  ancestors. 

1  am  also  authorized  in  making  the  statement  that  fully 
two-thirds  of  those  persons  requiring  aid  from  city  and  Slate 
are  descendants  of  inebriate  parents.  In  one  of  our  promi- 
nent lunatic  asylums  637  cases  were  traced  to  intemperance 
as  the  assignable  cause  of  their  insanity.  The  statistical 
accounts  of  the  State  of  New  York  give  the  following  facts  : 
In  the  poor-house  of  Ontario  county  there  were  113  inmates. 
These,  together  witli  their  ancestors  for  three  generations, 
living  and  dead,  represented  90  families,  and  in  these  fam- 
ilies there  were  168  dependents,  26  insane,  12  idiots,  103 
inebriates.  In  Columbia  county,  118  inmates,  representing 
114  families,  had  143  dependents,  12  insane,  32  idiots,  127 
inebriates.  In  Yates  county,  32  inmates  represented  26 
families,  of  whom  59  had  been  dependent,  4  insane,  2  idiots, 
and  31  inebriates.  In  Kings  county,  1,876  inmates  repre- 
sented 1,668  families,  2,039  dependent,  755  insane,  i-3  idiots, 
and  973  inebriates.  Herkimer  county  had  77  inmates,  rep- 
resenting 67  families,  128  dependents,  21  insane,  12  idiots, 
and  64  inebriates.  The  total  in  the  alm.s-houses  of  the  State 
was  12,614  inmates,  who  represented  10,161  families,  whose 
members  for  three  generations,  living  and  dead,  had  among 
them  14,901  dependents,  4,968  insane,  844  idiots,  and  8,863 
inebriates.  In  round  numbers,  here  are  10,000  families  who 
have  produced  15,000  paupers,  or  3  paupers  for  every  2 
families — of  insane,  about  i  for  every  2  families  ;  of  insane, 
inebriates,  and  idiots  combined,  about  15,000  or  3  to  every 

2  families." 

Dr.  Wright  asks  :  Is  there  a  form  of  inebriety  allied  to 
those  neuroses  which  mark  a  constitutional  defect  in  nerve 
balance,  a  defect,  the  conditions  of  which  are  transmissible 
by  heredity  ?     Some   noted  gentlemen   deny  the  reality  of 


STATISTICS    OF   HEREDITY.  163 

the  dipsomanical  diathesis,  and  especially  deny  that  such  a 
constitutional  proclivity  can  be  handed  down  from  ancestry. 
The  real  importance  of  the  subject  causes  one  to  inquire 
with  a  good  deal  of  interest:  "What  do  the  highest 
authorities  say  on  these  points  ?  The  testimony  of  such 
eminent  physicians  as  Hughes,  Parrish,  Crothers,  Mann, 
Mason,  and  others  in  this  country  ;  and  Clouston,  Mitchell, 
Kerr,  Peddie,  Cameron,  Carpenter,  and  a  host  of  others  in 
Great  Britain,  any  one  of  whom  is  fully  competent  to 
decide  on  the  merits  of  the  question,  and  who  have  con- 
scientiously studied  inebriety  for  some  years,  will  not  be 
taken.  Their  great  interest  in  the  subject  might  expose 
them  to  the  imputation  of  prejudice  in  viewing  the  facts. 
Authorities  who  are  supposed  to  contemplate  scientific 
principles  through  an  atmosphere  pure  and  uncolored  by 
sympathy,  are  the  only  ones  who  will  be  questioned.  The 
attempt  will  be  made  to  show  that  if  epilepsy,  spasmodic 
asthma,  prolonged  neuralgia,  hysteria,  suicidal  melancholia 
and  the  like,  are  constitutional  diseases,  then  dipsomania, 
or  as  it  is  called  by  some,  inebriety,  is  also  a  constitutional 
disease. 

Morel,  when  speaking  of  the  degeneration  and  final 
extinction  of  a  neurotic  family  strain,  gives  a  history  from 
his  own  personal  observation  thus  :  "  First  generation — 
immorality,  depravity,  alcoholic  excess,  and  great  moral 
degradation  in  great-grandfather  who  was  killed  in  a  tavern 
brawl.  Second  generation — hereditary  drunkenness,  mania- 
cal attacks  ending  in  general  paralysis  in  grandfather. 
Third  generation — Sobriety,  delusions  of  persecution,  and 
homicidal  tendencies  in  father.  Fourth  generation — defective 
intelligence,  mania  at  sixteen  ;  transition  to  idiocy  ;  gener- 
ative functions  feeble  ;  sisters  imbecile  ;  wife  had  a  bastard 
child  of  good  constitution."  When  treating  of  heredity, 
Maudsley  divides  the  subject  into  three  branches  :  ist, 
heredity  of  the  same  form  ;  2d,  of  allied  form  ;  3d,  with 
transformation  of  neurosis,  as  when  the  ancestral  defect  was 


164  DISEASES    OF    INEBRIETY. 

simply  a  nervous  disease.  Of  heredity  of  tlie  same  form, 
this  author  says  :  "  That  is,  when  a  person  suffers  from  the 
same  kind  of  mental  derangement  as  a  parent,  whicli  he  sel- 
dom does,  except  in  cases  of  suicide  or  dipsomania."'  Dr.  M. 
says  in  another  place  :  "  This  mingling  and  transformation 
of  neurosis  which  is  observed  sometimes  in  the  individual, 
is  more  plainly  manifest  when  the  history  of  the  course  of 
nervous  disease  is  traced  through  generations."  The  book 
of  inebriety  is  open  everywhere  and  to  everybod}'.  But  to 
study  its  pages  aright,  particularly  in  respect  to  its  habits 
of  descent  through  individuals  and  generations,  the  observer 
himself  must  abide  for  a  long  series  of  years  amongst  one 
and  the  same  community  of  people.  It  is  obvious  that  in 
this  way  only  can  he  study  the  facts  respecting  the  influence 
of  alcohol  upon  individuals  and  upon  families. 

In  the  work  already  cited  it  is  written  :  "With  respect 
to  an  individual's  legacy  from  his  parents,  he  inherits  not 
only  their  family  nature  .  .  .  but  something  from  their 
individual  characters,  as  these  have  been  modified  by  their 
sufferings  and  doings,  their  errors  and  achievements,  their 
development  or  their  degradation." 

Dr.  Blandford  {Insanity  and  its  Treatjnenf,  p.  139),  speaks 
as  follows  :  "As  I  have  said,  the  particular  cliaracter  of 
the  mania  or  melancholia  depends  on  the  constitution  of 
the  individual,  ,  .  .  and  the  same  person  may  at  one  time 
be  maniacal  and  at  another  melancholic.  It  is  true,  we  fre- 
quently see  the  same  form  in  successive  generations,  e.  g., 
suicidal  melanchol}^  and  hereditary  drunkenness.  He 
teaches  that- there  is  a  vast  number  of  cases  whei'e  the 
descending  form  is  different  from  its  parent  ;  and  that  the 
same  form  may,  or  may  not,  appear  in  posterity.  The  idea 
that  the  hereditary  transmission  of  different  but  inter- 
changeable neurotic  form  is  an  indication  of  the  insane 
temperament  is  universal  amongst  alienists.  Tliat  "alco- 
holism is  more  liable  to  produce  epilepsy,  or  idiocy,  than  to 
repeat   itself,"    places    alcoholism     (or    inebriety)    at    once 


STATISTICS    OF    HEREDITY.  165 

amongst  the  hereditary  and  insane  neuroses.  "  Hence,  I 
believe  springs  the  ever  renewed  insanity  inebriety  of  our 
lower  classes  .  ,  .  My  opinion  is,  that  amongst  the  lower 
classes  of  our  countrymen,  insanity  is  on  the  increase.  .  .  . 
There  is  a  degree  of  drunkenness  among  the  lower  classes 
of  this  country  that  is  not  found  in  the  higher.  .  .  .  The 
amount  of  drunkenness  is  enormous,  and  is  almost  confined 
to  the  lower  orders — below  the  shopkeeper  class." 

This  is  placing  habitual  drunkenness,  or  rather  the 
neurotic  mood  which  craves  intoxication,  very  closely  in 
alliance  with  those  neurotic  states  which  immediately  inter- 
change with  true  insanity,  it  does  indeed  classify  them 
together  as  one  family.  The  intense  desire  for  intoxication 
which  is  distinctive  of  the  dipsomaniac,  appears  to  issue 
from  some  unstable  or  abnormal  state  of  the  brain,  as  other 
lawless  and  unmanageable  nervous  symptoms  frequently 
do,  speaking  of  the  influence  of  parentage  in  impressing  a 
morbid  diathesis  upon  posterity,  uses  this  language  :  "The 
causes  of  insanity  may  come  into  operation  at  the  period  of 
conception.  We  should  expect  this  a  priori,  and  experience 
appears  to  prove  it.  We  allude  more  especially  to  the  case 
of  a  parent  begetting  children  when  drunk." 

"  When  mental  disease  is  transmitted,  does  the  form  of 
insanity  descend  ?  Very  frequently  this  appears  to  be  the 
case,"  says  Dr.  Tuke.  The  doctor  then  proceeds  to  give 
examples  from  various  authorities  of  the  direct  descent, 
from  ancestry  to  posterity,  of  hallucinations,  monomania, 
melancholia,  mania,  general  paralysis,  and  idiocy  ;  and 
then  he  adds  upon  his  own  authority  :  "  Of  dipsomania, 
the  cases  are  so  common  that  it  is  not  necessary  to  detail 
any  examples."  Dr.  Tuke  gives  a  table  "  Exhibiting  the 
proportion  of  hereditary  cases  /;/  the  different  forms  of 
insanity,  observed  in  the  Cricliton  Institution,  as  reported 
by  Dr.  Stewart."  Mania  descends  as  such  in  51  per  cent, 
of  cases  ;  melaneholia,  57  per  cent.  ;  monomania,  49  per 
cent.  ;  moral  insanity,  50  per  cent.  ;  idiocy  and  imbecility, 


166  DISEASES    OF    INEBRIETY. 

36  per  cent.  ;  dipsomtuiia,  63  per  cent.  ;  general  paralysis, 
47  per  cent.  ;  dementia  and  fatuity,  39  per  cent. 

Dr.  Wynter  says  :  "Among  the  more  special  forms  of 
moral  perversity,  or  as  the  alienist  physician  would  say, 
insanity,  which  are  transmitted  by  an  insane  parent,  may 
be  mentioned  dipsomania."  Again,  tiie  same  author 
speaks  of  "  the  known  fact  that  persistent  drunkards  plant 
the  seeds  of  insanity  and  the  other  allied  diseases  in  the 
offspring.  Once  planted  there,  the  fruits  may  be  diverse  ; 
in  one,  there  may  be  persistent  neuralgia  ;  in  another,  the 
ancestral  drunkenness  may  assume  the  form  of  dipsomania  ; 
while  another  may  be  affiliated  with  partial  paralysis  or 
with  epilepsy." 

Dr.  Forbes  Winslow  declares  :  "  I  maintain,  and  facts 
clearly  demonstrate  my  position,  tiiat  there  is  a  vast 
amount  of  crime  committed  by  persons  who  occupy  a  kind 
of  neutral  ground  between  positive  mental  derangement 
and  mental  sanity.  I  do  not  support  the  dangerous 
opinion  that  all  crime  is  referable  more  or  less  to  aber- 
ration of  mind,  but  I  do  affirm  that  in  estimating  the  ^w^i^/z/ 
of  puJiishment  to  be  awarded,  it  is  the  dut}'^  of  the  judge,  not 
only  to  look  at  the  act  itself,  but  to  consider  the  physical 
condition  of  the  culprit,  his  education,  moral  advantages, 
prior  social  condition,  his  early  training,  the  temptations  to 
which  he  has  been  exposed,  and,  above  all,  whether  he  has 
not  sprung  from  intemperate,  insane,  idiotic,  and  criminal 
parents." 

Dipsomania  is  declared  by  authorities  to  be  one  of  the 
hereditary  transmissible  neuroses,  wliich  is  interchangeable 
with  other  neuroses  that  are  undisputably  allied  to  insanity. 
Dipsomania  is  an  aptitude  for  intoxication,  but  it  is  an  apti- 
tude that  is  not  subject  to  rules  or  laws.  It  is  pathological 
for  it  is  insatiable,  unmanageable,  in  fact,  an   outlaw. 

Dr.  Elam  asserted  :  "  The  offspring  of  the  confirmed 
drunkard  will  inherit  either  the  original  vice  or  some  of  its  count- 
less protean  transformations^ 


STATISTICS    OF    HEREDITY.  167 

Dr.  Anstie  affirms  :  "  In  the  course  of  a  large  experi- 
ence of  alcoliolism  among  hospital  out-patients,  I  have 
been  greatly  struck  witli  the  number  of  drinkers  who  have 
informed  me  that  their  relatives  eitlier  on  the  paternal  or 
maternal  side  have  been  given  to  drink  ;  my  own  experi- 
ence has  led  me  to  a  firm  conviction  that  particular  causes  of 
nervous  degeneration  affecting  individuals,  do  very  fre- 
quently lead  to  the  transmission  to  the  offspring  of  those 
persons  of  an  enfeebled  nervous  organization  which  ren- 
ders them  peculiarly  liable  to  the  severer  neurosis  and 
which  also  makes  them  facile  victims  of  tlie  temptations  to 
seek  oblivion  for  their  mental  and  bodily  pains  in  narcotic 
indulgence.  I  believe  that  things  often  work  in  a  vicious 
circle  to  this  end,  and  that  the  nervous  enfeeblement  pro- 
duced in  an  ancestor  by  great  excesses  in  drink,  is  repro- 
duced in  his  various  descendants  with  tlie  effect  of  produc- 
ing insanity  in  one,  epilepsy  in  another,  neuralgia  in  a 
third,  alcoholic  excesses  in  a  fourtli,  and  so  on.  Among  the 
higher  classes,  where  it  is  easier  than  in  the  case  of  the  poor 
to  obtain  tolerably  complete  family  histories  extending 
over  two  or  three  generations,  careful  inquiry  elicit  facts  of 
this  kind  with  surprising  frequency.  So  strong  is  the  im- 
pression left  on  my  mind  by  what  I  have  observed  in  this 
direction,  that  I  am  inclined  to  believe  that  the  great  ma- 
jority of  most  inveterate  and  hopeless  cases  of  alcoholic 
excesses  among  the  higher  classes  are  produced  by  two 
factors,  of  which  the  least  important  is  the  circumstance  of 
external  momentary  temptation,  in  which  the  person  has 
been  placed  where  the  more  momentous  and  mighty  canse  is 
derived  from  an  inherited  nervous  weakness,  which  renders 
all  kinds  of  bodily  and  mental  trouble  specially  hard  to  be 
borne. 

Dr.  Wright  says  :  "  Observation  teaches  no  lesson  more 
clearly,  unmistakably  and  universally,  than  tlie  absolute 
certainty  of  heredity.  Nothing  escapes  it — neither  the 
slightest   physical   formation  or  movement,  nor  the  faintest 


168  DISEASES   OF   INEBRIETY. 

hint  of  a  mental  or  moral  impulse.  Race  propagation  is 
simply  the  handing  down  of  the  salient  features  of  one  gen- 
eration to  succeeding  ones.  There  is  no  necessary  progres- 
sion, deterioration,  or  change.  But  heredit}^,  in  its  highest 
sense,  is  particularly  concerned  and  exact  in  transmitting 
an  immense  number  of  personal  cliaract^eristics  derived 
from  the  innumerable  associations,  good,  bad  and  indiflfer- 
ent,  that  have  been  connected  viMth  individual  existence. 

"  The  main  features  of  humanity  are  one  and  unvarying  ; 
but  the  acquired  "  peculiarities  "  of  families,  and  especially 
of  individuals,  are  the  reflections  of  the  possibilities  of 
human  life.  They  measure  the  capabilities  and  the  defects 
of  man's  nature,  as  they  are  susceptible  of  development  by 
personal  contact  with  the  ever-changing  situations,  and  the 
endless  accidents  of  time.  To  the  descent  by  heredity  of 
the  acquired  characterics  of  individuals  in  varying  forms, 
and  by  unnumbered  vicarious  substitutions,  we  owe  the 
strength  as  well  as  the  weakness  of  the  race.  The  poten- 
tialities of  humanity,  exhibited  in  the  beauty  of  one,  the 
eloquence  of  another,  the  artistic  genius  of  another,  the 
fortitude  and  patriotism  and  unselfishness  of  others,  illus- 
trate and  also  demonstrate  the  existence  in  the  human  race 
of  qualities  far  greater  and  more  glorious  than  the  highest 
achievements  of  minds  merely  symmetrical  can  possibly 
evince.  These  potentialities  are  the  outcome  of  personal 
traits  formulated  in  individuals  by  contact  with  the  experi- 
ences of  life,  and  transmitted  in  endless  variety  of  combina- 
tion and  form  by  the  power  of  heredity." 

Dr.  Kerr  :  "  This  heredity  may  be  regarded  as  two-fold. 
There  is  the  direct  alcoholic  inheritance.  That  drunkards 
beget  drunkards  is  an  axiom  dating  from  very  early  times. 
There  are  also  large  numbers  of  children  born  with  an 
inherited  and  extremely  delicate  susceptibility  to  the 
narcotizing  action  of  alcoholic  intoxicants,  whose  parents 
were  not  in  the  habit  of  getting  drunk,  but  drank  regularly 


STATISTICS   OF    HEKEDITr.  169 

and  freely,  physiologically  intemperate,  though  considered 
by  the  world  to  be  models  of  sobriety. 

"  There  is  also  the  indirect  inheritance  of  alcohol.  Under 
this  category  are  ranged  individuals  who  have  no  special 
proclivity  to  excess,  who  have  no  direct  though  latent 
proneness  to  inebriety,  but  who  are  weighted  from  their 
birth  by  a  controlling  power  too  feeble  to  stay  the  advances 
of  alcohol  within  their  very  being.  Alcohol,  if  it  gain  an 
entrance  into  such  constitutions  by  however  tiny  an  inlet, 
slowly  yet  steadily  widens  the  aperture  by  increasing  in 
volume,  as  the  dykes  built  to  resist  the  encroaches  of  the 
ocean,  till  all  the  defenses  are  swept  away  by  the  over- 
powering and  overwhelming  flood.  In  no  inconsiderable 
proportion  of  cases  this  defective  power  of  control  is  the 
product  of  alcoholic  indulgence  on  the  part  of  one  or  both 
parents. 

"  I  have  seen  the  alcoholic  habit  in  the  parent  bear  diverse 
fruit  in  the  persons  of  the  offspring,  one  sister  being  ner- 
vous, excitable,  and  inebriate,  a  second  consumptive,  a 
third  insane  ;  one  brother  an  epileptic  and  a  periodic 
inebriate,  the  second  in  an  asylum,  the  third  a  victim  to 
chronic  inebriety.  In  another  instance,  where  all  the  four 
children  have  become  habitual  drunkards,  the  grandfather 
had  also  been  addicted  to  excess. 

"  The  heredity  is  sometimes  crossed.  The  daughters  of  a 
drinking  father,  and  the  sons  of  a  drinking  mother  may  be 
the  only  children  affected  with  the  inebriate  taint, 

"  The  heredity  may  be  either  insane  or  inebriate.  As 
inebriate  parents  not  unseldom  beget  insane  offspring,  so 
from  insane  parentage  we  sometimes  get  inebriate  children. 
The  heredity  may  be  of  some  other  type.  Any  transmitted 
disease  or  effect  of  disease  which  increases  nervous  sus- 
ceptibility, unduly  exhausts  nerve  strength,  and  weakens 
control,  may  bear  a  nervine  crop,  in  the  form  of  asthma  in 
one  child,  hysteria  in  another,  epilepsy  in  another,  idiocy  in 
another,  and  inebriety  in  another," 


170  DISEASES    OF   INEBRIETY. 

Dr.  Dacaiene  concludes  an  exliaustive  study  as  follows: 

"  ist.  Under  tlie  name  liereditary  alcoholism  is  included 
the  totality  of  tlie  pathological  manifestations  transmitted 
to  a  child  by  one  or  the  other  of  his  parents  who  are  drink- 
ers, and  sometimes  both. 

"  2d.  The  inheritor  of  this  taint,  as  well  as  the  drinker 
himself,  can  hand  down  not  only  his  own  vice,  but  a  special 
morbid  tendency,  a  particular  neuropathic  state,  which  can 
always  be  charged  to  inebriety. 

"3d.  The  alcoholic  inheritance  may  at  first  be  dormant. 
When  it  exists  it  shows  itself  in  infancy,  or  later,  or  in 
another  generation.  It  shows  itself  as  congenital  paralysis, 
convulsions,  epilepsy,  hypochondriasis,  idiocy,  etc. 

*  4th.  The  increase  in  the  number  of  the  insane,  of  the 
number  of  suicides,  of  crimes  and  misdemeanors,  such  are 
the  results  of  hereditary  alcoholism. 

"5th.  It  is  in  hereditary  alcoholism  that  can  be  found 
the  explanation  of  certain  monsters  who  come  from  time  to 
time  to  horrify  society  and  scandalize  the  courts  of  law. 

"  6th.  These  degenerate  beings  are  smitten  with  sexual 
impotence.  T!ie  female  inebriate  is  apt  to  abort,  and  lastly 
the  mortality  of  the  newly-born  among  drinkers  reaches  a 
figure  truly  frightful. 

"  7th.  It  has  often  been  proved  that  in  the  case  of  drink- 
ers, there  is  a  loss  in  stature  and  physical  force. 

"  8th.  To  sum  up  hereditary  alcoholism  as  well  as  the 
acquired,  determines  an  enfeeblement  of  the  species,  the 
destruction  of  the  family,  and  the  degeneration  and  abase- 
ment of  the  race. 

"9th.  From  amedio-Iegal  point  of  view,  the  hereditary 
inebriate,  in  particular  the  dypsomaniac,  should  be  regard- 
ed most  of  the  time  as  irresponsible,  or  at  least  his  respon- 
sibility should  be  regarded  as  very  limited.  He  is  a  sick 
man, who  should  be  cared  for,  remembering  that  he  presents 
an  undeniable  propensity  to  sickness,  that  he  possesses  a 
defective  intellectual   organization,  in   a    word  that  he   is  a 


STATISTICS    OF   INEBEIETY.  171 

degenerate.  If  the  moral  sense  has  not  completely  disap- 
peared in  his  case,  at  least  its  use  is  not  accurately  regula- 
ted. The  judge  then  ought  to  take  into  account  this  moral 
state  in  appreciating  Iiis  acts. 

Dr.  Lykke,  Copenhagen,  has  shown  clearly  that  heredity 
is  a  powerful  factor  in  the  origin  of  dipsomania.  He 
indicated  that  psychical  abnormities  in  the  parents  are 
developed  in  the  next  generation,  and  that  if  an  improve- 
ment of  the  morbid  condition  is  not  attained  by  inter- 
marriage, the  result  will  be  complete  degeneration.  One 
of  the  prominent  symptoms  of  such  degeneration  is  a  lack 
of  moral  capacity,  and  the  preponderance  of  ungovernable 
instincts  and  dipsomaniac  tendencies.  Hence  he  supposes 
dipsomania  to  be  a  symptom  of  hereditary  degeneration  or 
insanity. 

Briihl  Cramer,  from  a  long  examination  of  this  subject, 
concludes  that  drunken  parents  are  seldom  prolific,  and 
when  so,  the  children  are  stupid,  malicious,  and  full  of 
mental  defects.  Skae  and  Thompson  have  both  made  deep 
researches  into  the  hereditary  disposition.  The  cases  which 
they  examined  were  largely  of  the  mixed  form  of  dipso- 
mania, and  all  sliowed  decided  tendencies  to  insanity. 
Skae  found  in  eighty-two,  thirty-two  cases  of  inherited 
dipsomania.  In  the  parents  of  the  cliildren  of  the  collateral 
branches,  he  found  drunkenness,  dipsomania,  suicide,  and 
other  mental  diseases.  Thompson  found  in  twenty  cases, 
nineteen  in  which  inebriety  was  clearly  inherited.  Many  of 
these  families  containing  two,  four,  and  eight  members, 
were  all  either  drunken,  epileptic  or  insane.  In  three 
families  which  I  have  studied,  where  both  parents  were 
drunken  and  insane,  every  single  member  following  suf- 
fered from  mental  defects,  of  which  epilepsy,  dipsomania, 
and  suicide  were  most  common. 

All  authors  agree  tiiat  heredity  is  the  prominent  cause 
in  the  etiology  of  dipsomania  ;  but  they  disagree  as  to  the 
place  it    should   occupy  in   the   nosology,   and    whether   it 


172  DISEASES    OP   INEBRIETY. 

should  be  considered  as  a  principal  disease  or  only  as  a 
symptom.  It  is  clear  that  insanity  and  nervous  diseases 
develop  into  dipsomania  in  the  next  generation,  and  vice- 
versa.  The  intimate  relation  between  these  diseases  is  evi- 
dent. 


CHAPTER  XIX. 

GENERAL     CONSIDERATIONS      OF     THE    PATHOLOGY    OF 
INEBRIETY. 

When  a  considerable  portion  of  alcohol  is  consumed  at 
one  time  by  a  person  perfectly  sober,  certain  characteristic 
appearances  will  usually  be  observed  to  follow  immediately. 
There  is  a  decided  shock  throughout  the  whole  system. 
The  face  will  often  be  very  pale.  This  will  be  more  notice- 
able in  nervous  and  sensitive  persons.  The  muscles  of  the 
face  will  be  drawn,  and  fixed  in  position.  The  eyes  will  be 
bright  and  glittering,  while  their  movements  will  be  quick 
and  constrained.  The  mouth  will  be  firmly  shut  ;  but  when 
an  effort  is  made  to  speak,  the  lips  will  be  spasmodically 
affected.  The  breath  will  be  short  and  panting,  the  pulse 
accelerated,  and  the  articulation  interrupted  and  difficult. 
The  entire  body  will  be  affected  by  a  trembling  movement 
and  a  sensation  of  shivering.  In  fact,  there  will  be  a  brief 
nervous  chill.  All  these  features  appear  at  one  and  the 
same  time.  The  period  of  their  duration  is  very  short,  how- 
ever. After  the  lapse  of  five  or  ten  minutes  at  most,  the 
second  stage,  characteristic  of  heavy  drinking,  will  come  into 
view.  Movements  will  appear  unnatural,  and  very  quickly 
will  seem  absolutely  distorted  and  staggering.  Intellectual 
activity,  also,  will  speedily  appear  both  irregular  and 
unsteady.  The  voice  very  likely  will  be  elevated,  and  an 
incessant  chatter  of  speech,  laden  with  absurd  boasting, 
will    din    the   ear.     The    brim  of   the    hat  will   perhaps  be 

173 


174  DISEASES    OF   INEBRIETY. 

thrown  upward,  or  the  hat  itself  placed  upon  the  side  of 
the  head,  or  thrown  backward,  revealing  the  noble  forehead. 
Indeed,  the  conditions  are  now  all  present  for  a  full  display 
of  aggressive  vulgarity  and  foolishness. 

The  ruffianly  instincts  being  aroused  by  alcohol,  the 
garb  of  the  ruffian  is  put  on.  For  truly  it  is  a  fact,  that 
when  a  man,  being  sober  himself,  arranges  his  attire  like 
that  of  a  rowdy,  as  thrusting  his  pantaloons  inside  his  boot 
tops,  turning  upward  the  brim  of  his  hat  both  in  front  and 
behind,  and  tying  a  handkerchief  loosely  about  his  neck — 
he  will  begin  to  feel  like  a  rowdy,  and  to  act  like  one.  He 
will,  perchance,  stick  his  fists  down  deep  into  his  pockets, 
while,  possibly,  he  pours  forth  profanity  and  tobacco-juice 
in  equal  volumes. 

This  description,  of  course,  is  not  of  universal  applica- 
tion. In  different  persons  there  are  considerable  modifica- 
tions in  these  particulars,  owing  partly  to  peculiarities  of 
individual  constitutions,  and  partly  to  the  kind  of  alcohol 
contained  in  the  liquor  that  has  been  taken.  But,  let  the 
constitutional  disposition  be  what  it  may,  the  full  drink  of 
alcoholic  liquor  will  induce  displays  in  movement,  mind, 
and  morals,  that  are  unwortiiy  of  the  individual  :  and,  the 
liquor  being  the  same,  these  displays  will,  in  a  given  indi- 
vidual, always  be  practically  the  same. 

Differences  in  the  kind  of  alcohol  will  doubtless  occasion 
considerable  difference  in  the  conduct  of  those  who  indulge 
in  the  alcoholic  habit.  Dr.  Norman  Kerr,  in  his  very  able 
work  on  Inebriety,  says  :  "All  alcohols  are  poisonous. 
The  least  poisonous  are  the  alcohols  of  wine.  More  poison- 
ous are  the  alcohols  of  beet-root.  Still  more  deadly  are 
the  alcohols  of  corn  (all  kinds  of  grain)  ;  and  the  most 
potent  and  pestiferous  are  the  alcohols  from  potatoes. 
Cider  inebriates  are  usually  more  heavy  and  stupid  than 
alert  and  offensive.  Amylic  alcohol  is  nearly  four  times  as 
poisonous  as  ethylic."  Amylic  alcohol  quickly  brings  on 
muscular    tremors    and     delirium     tremens — whereas    the 


PATHOLOGY    OF   INEBRIETY.  175 

ethylic  does  not  readily  produce  such  effects,  if  it  does  at 
all.  It  is  therefore  perceived  that  while  there  is  a  sameness 
in  the  physiognomy  of  conduct  under  the  influence  of  alco- 
hol, tliere  is  likewise  a  certain  difference  in  details,  in 
accordance  with  the  particular  kind  of  alcohol  that  is  taken, 
A  drunken  man  will  not  be  of  so  unruly  and  satanic  tem- 
per after  partaking  of  wine,  or  of  stronger  drink  derivetl 
from  wine,  as  he  will  after  partaking  of  beet  or  potato 
whiske}' ;  and  he  will  come  out  of  his  drunken  state  more 
quickly,  and  witli  less  distress  in  the  former  than  in  the 
latter  contingency. 

There  are  many  persons  who  drink  alcoholic  liquors  with- 
out any  driving  impulse  to  intoxication.  It  is  a  common 
belief  tiiat  alcohol  adds  to  the  natural  powers  of  the  organ- 
ism ;  and  hence,  alcohol  is  frequently  taken  in  order  that, 
tiirough  an  intensified  capacity,  ends  may  be  secured  that 
would  otherwise  be  impossible.  In  this  respect,  the  occa- 
sional drunkard  is  to  be  distinguished  from  the  spasmodic 
or  impulsive  drunkard,  whose  whole  aim  is  to  secure  intox- 
ication for  its  own  sake,  and  also  to  secure  it  quickly  and 
completely. 

Drinking  fro7n  association. — There  are  many  persons  who 
drink  alcoholic  liquors  only  as  accidental  contingencies  and 
opportunities  offer.  They  do  not  purposely  seek  the  means 
of  intoxication.  The  motives  which  actuate  them  in  drink- 
ing are  wholly  derived  from  circumstances  external  to 
themselves  and  which  are  truly  fortuitous.  Yet  the  occa- 
ssional drinker  cannot  be  said  to  be  devoid  of  even  strong 
motives  for  his  indulgence.  Sometimes  a  man  will  drink 
alcoholic  liquor  simply  because  he  happens  to  be  in  com- 
pany with  others  who  are  drinking.  The  natural,  but  occa- 
sionally idle  sympathy,  which  is  so  apt  to  bind  men  together 
in  a  common  course  of  conduct,  is  sufficiently  powerful  to 
lead  to  a  community  of  action,  even  in  the  matter  of  drink- 
ing liquors.  Such  cause  for  drinking  may  be  operative  on 
public  days,  or  in  companies  that  are  engaged  in  enterprises 


176  DISEASES    OF    INEBRIETY. 

wherein  there  is  unity  of  feeling  and  purpose — and,  of 
course,  good  fellowship — as,  at  log-rollings,  barn-raisings, 
and  the  like. 

Drinking  from  this  cause  is  not  apt  to  lead  to  very  seri- 
ous consequences.  It  is  true,  however,  that  if  there  is  any 
considerable  constitutional  irritability  of  nerve  in  an  indi- 
vidual, even  an  accidental  indulgence  may  ignite  a  flame 
tliat  can  never  be  extinguished  ;  and  in  this  way  the  occa- 
sional drinker  ma}'^  become  an  habitual  drunkard. 

The  pleasurable  sensations  of  early  drunkenness  are  not 
so  pronounced  in  the  occasional  drinker  as  they  are  apt  to 
be  in  tlie  spasmodic  inebriate.  This  migiit  be  expected 
when  it  is  remembered  that  an  exquisite  sense  of  mental 
and  physical  delight  is  one  of  the  ruling  inducements  to 
frequent  intoxication — that  is,  to  intoxication  for  its  own 
sake.  In  a  stolid  mind,  rage  and  hate  are  not  unlikely  to 
be  aroused  by  alcohol,  instead  of  generosity  and  good 
temper. 

Misfortunes^  either  domestic  or  in  business,  often  lead  to 
drinking.  The  benumbing  influence  of  tlie  alcoholic  potion 
renders  callous  the  distressed  mind  and  quivering  nerve. 
It  is  not  always  for  excitement  that  alcohol  is  taken  into 
the  system.  It  is  sometimes  taken  to  secure  repose  ;  and 
tliis  repose  is  simply  paralysis,  more  or  less  complete.  In 
the  paralysis  of  sensation,  pain  is  abated  ;  in  the  paralysis 
of  the  co-ordinating  nerve  centers,  moral  and  sympathetic 
afflictions  no  longer  harass  the  mind.  Alcohol  is  a  com- 
plete remedy  ;  for  the  paralysis  of  alcohol  extends  through- 
out the  whole  body.  It  is  seen  in  the  motor  system 
through  the  staggering  gait,  the  imperfect  articulations,  the 
distorted  countenance.  It  is  perceived  in  the  organs  of 
sensation  through  the  general  numbness  and  the  absence 
of  the  sense  of  feeling.  The  intellectual  powers  exhibit 
the  paralyzing  properties  of  alcohol,  through  confusion  of 
mind,  distortions  in  ideas,  and  in  the  irregular  operations 
of   the   imagination.       The   same   paralysis   is  seen  in   the 


PATHOLOGY  OF   INEBRIETY.  177 

moral  sense  through  the  loss  of  that  sense,  and  the  inflow 
of  untruthfulness,  deceit,  and  prevarication. 

A  deatli  in  the  family  is  followed  sometimes  by  deep 
potations  on  the  part  of  the  survivors,  with  the  object  of 
inducing  a  forgetfulness  or  partial  unconsciousness  of 
trouble.  Yet  the  time  thus  consumed  is  expended  in  vain. 
It  cannot  serve  to  shorten  the  period  which  truly  is  requisite 
to  assuage  the  intensity  of  sorrow.  In  truth,  when  this 
drunkenness  has  passed  away,  the  poisoned  nerves  are  in  a 
pitiable  state  of  excitement  and  tremor,  much  greater  than 
oppressed  them  in  the  first  place.  With  renewed  distress 
and  intensified  grief,  the  mind  is  compelled  to  await  all  the 
longer  for  consolation  and  repose.  It  is  in  this  condition 
of  mind  and  nerve — after  drinking  is  abated — when  some- 
times suicide  is  invoked  to  vanquish  once  for  all  the  com- 
bined horrors  of  grief  and  intemperance. 

Alcohol  iniwked  to  increase  the  power  of  physical  endurance. — ■ 
The  casual  drinker  takes  alcoholic  liquors  oftentimes  with 
the  view  of  increasing  the  powers  of  bodily  endurance.  The 
acuteness  of  the  feelings  being  subdued  by  the  nervous  tor- 
por superinduced  by  alcohol,  the  sensations  of  cold  and  heat 
are  not  keenly  presented  to  the  mind.  Yet  this  fact  does 
not  give  the  physical  organism  any  immunity  from  the 
extreme  effects  of  changes  in  the  temperature.  Experience 
has  shown  that  persons  exposed  to  cold,  wet,  and  fatigue, 
sustain  themselves  much  better  without  alcohol  than  with 
it.  The  truth  is,  that  alcohol  reduces  the  temperature  of 
the  human  body,  as  the  thermometer  fully  demonstrates. 
Therefore,  the  drunken  man  perishes  from  cold  more  readily 
than  the  sober  man.  For,  not  only  does  alcohol  abstract 
oxygen,  the  source  of  heat,  from  the  blood,  and  thus  reduce 
the  fires  of  ordinary  physiological  combustion,  but  it 
benumbs  and  paralyzes  certain  nerve  centers,  whose  office  it 
is  to  preside  over  the  regulation  of  animal  heat.  As  a 
remedy  in  violent  fevers,  alcohol  is  extensively  used  for 
reducing  the  dangerous   heat  of  the  blood.     As  a  trickster 


178  DISEASES    OF   INEBRIETY. 

and  fraud,  nothing  can  exceed  alcohol,  if  indeed,  it  can  be 
equaled.  He  who  relies  upon  alcohol  to  warm  him  when 
cold  is  cheated  and  deceived. 

Alcohol  as  sustaining  muscular  efficiency. — Men  frequently 
take  ardent  spirits  with  the  notion  that  it  will  increase  the 
bodily  strength.  The  professional  athlete,  however,  who 
understands  the  subject,  will  carefully  avoid  alcohol  when 
upon  the  verge  of  action.  There  are  several  sound  reasons 
for  this,  (a)  The  benumbing  effect  of  alcohol  upon  the 
nervous  powers  is  universal.  It  includes  the  muscular  sys- 
tem in  common  with  all  others.  The  readiness  of  muscular 
contraction — its  exact  concord  of  action  throughout  the 
whole  of  its  substance,  and  the  completeness  of  its  move- 
ment, all  depend  upon  the  natural  strength,  quickness,  and 
sharpness  of  the  nervous  influence  whicii  is  brought  into 
play.  But  this  influence  is  dwarfed  and  minimized  by  the 
paralyzing  impression  of  alcohol,  (b)  The  heart  in  intoxi- 
cation is  thrown  into  increased  action  to  the  extent  that  the 
additional  duties  which  very  great  muscular  effort  would 
impose  upon  it,  are  too  great  for  its  capacity,  (c)  The 
lungs  refuse  the  breath  requisite  to  extraordinary  muscular 
effort  when  a  man  is  drunk  ;  for  in  drunkenness  they  have 
a  double  duty  to  perform.  They  are  busy,  not  only  in 
exhaling  the  alcoholic  poison,  but  also  in  disposing  of 
the  deleterious  material  ordinarily  thrown  out  by  them. 
Consequently,  when  uncommon  muscular  effort  throws 
upon  them  an  excessive  volume  of  blood,  they  are  unable 
properly  to  dispose  of  it.  The  man  speedily  gets  out  of 
breath,  and  is  compelled  to  moderate  his  efforts. 

The  base  ball  player  is  sadly  deficient  when  under  the 
influence  of  liquor.  He  cannot  judge  correctly  with  respect 
to  distance,  nor  tell  the  true  direction  or  velocity  of  a  fly- 
ing ball.  He  can  neither  catch  nor  throw  with  his  usual 
accuracv.  His  eyes  are  wanting  in  alertness  of  action,  if 
not  in  correctness  of  vision.  His  movements  and  his  judg- 
ment  are   equally   at   fault.     The   disabling   powers  of  the 


PATHOLOGY  OF   INEBRIETY.  179 

alcoholic  potion  are  plainly  displayed  in  the  destruction  of 
the  normal  relationship  whicli  should  exist  between  the 
great  divisions  of  human  nature — mind  and  body.  The 
perceptive  faculties,  as  observed  through  the  operations  of 
common  sensation  and  the  sense  of  sight,  are  benumbed, 
while  the  muscular  alacrity  answering  the  calls  of  volition 
and  judgment  is  absent.  In  brief,  the  atlilete  has  not  vol- 
untary control  of  his  muscular  powers  when  under  the 
dominion  of  alcohol,  for  paralysis,  in  whatever  degree  it 
exists,  withdraws  function  in  a  corresponding  degree  from 
volition.  Yet  alcohol  is  wonderfully  complicated  as  well 
as  positive  in  its  activities — volition  itself  being  dull  and 
paralyzed  as  well  as  the  muscular  system. 

Similar  considerations  are  applicable  to  almost  all  ath- 
letic or  muscular  exercises.  The  swordsman  and  the 
pugilist  must  possess  not  only  a  steady  but  a  correct  nerve. 
It  is  indispensable  to  success  that  the  eye  and  the  hand  be 
untrammeled  and  alert,  but  they  should  also  be  in  exact 
harmony  with  each  other  in  quickness  of  perception  and 
movement.  The  details  should  be  right,  and  the  great 
movements  of  the  system,  which  combine  the  details,  should 
be  unimpeded.  The  prize  fighter  knows  the  fact  that  the 
universal  dullness  of  nerve  wrought  upon  the  organism  by 
alcohol  is  fatal  to  his  efforts  for  victory.  It  is  amazing  to 
see  the  absolute  confidence  with  which  a  person  under 
alcoholic  influence  views  his  powers,  when  the  knowledge 
of  the  disabilities  imposed  by  it  are  not  recognized.  In 
him,  all  the  nagging  asperities  of  nervous  activity  have  dis- 
appeared. Nothing  seems  impossible  to  the  transcendent 
egoism  of  a  drunken  man.  The  very  suggestion  of  unfit- 
ness or  mistake  is  scouted  by  him.  Equally  unable  to  fore- 
see, or  appreciate  difficulties,  he  has  no  faith  in  their 
existence. 

One  A ,  a    physician  of  ability,  while  considerably 

intoxicated,  was  handling  a  pistol,  and  accidentally  dis- 
charged it.     The   ball   flew  near  his   wife's  head,  and  shat- 


180  DISEASES    OF    INEBRIETY. 

tered  a  looking-glass  behind  her.  He  was  astonished 
exceedingly,  and,  with  respect  to  this  matter,  he  remains  so 
to  this  day.  His  confidence  in  the  absolute  infallibility  of 
his  care  and  caution  was  simply  impregnable — as  it  is, 
indeed,  in  every  man  who  is  drunk.  Yet  in  this  very  thing 
he  was  terribly  deceived  and  beguiled  by  alcohol.  The 
sense  of  feeling  in  his  hand  was  benumbed.  He  grasped 
the  pistol  with  more  force,  and  pressed  upon  the  trigger 
more  firmly,  than  he  had  any  idea  of,  by  reason  of  his 
impaired  sense  of  feeling.  The  truth  is,  the  confident 
approach  of  a  drunken  man  is  always  amazing.  His  sense 
of  feeling  is  dulled,  and  he  seizes  the  person  of  another 
in  a  rude  manner.  His  grasp  is  painful  because  it  is  vio- 
lent. The  inebriate  unconsciously  exerts  considerable  force 
in  his  movements,  in  order  to  feel  that  he  is  really  in  con- 
tact with  tilings  or  persons  exterior  to  him.  In  the  case  of 
A ,  in  whose  liands  the  pistol  was  discharged,  the  har- 
mony of  action  between  the  eye  and  hand  was  deranged, 
through  deadening  of  the  nervous  sensibility.  The  con- 
sequence was  that,  what  he  supposed  was  a  normal  com- 
munity of  action  between  distant,  but  auxiliary  parts,  was 
an  unnatural  and  inharmonious  relationship.  It  was  in 
obedience  to  that  unrecognized  condition,  affecting  alike 
mind  and  sensation,  that  the  explosion  took  place,  and  not 
from  a  condition  thoroughly  regular  and  under  the  control 
of  volition. 

How  often  has  a  drunken  man  had  cause  to  bless  his 
"good  luck,"  when  a  gun  went  off  without  dealing  death, 
while  in  his  hands  ;  and  how  often  again,  has  regret  and 
remorse  followed  him  through  life,  because  some  weapon 
has  been  accidentally  fired  by  his  awkward  and  trembling 
movements — maiming,  or  possibly  killing  some  friend  or 
companion. 

A  young    man,  Samuel  L ,  recently  shot    a    female 

companion   through   the  head,  killing  her  instantly.     They 
were  both  partially  intoxicated.     The  pistol  was  of  cheap 


PATHOLOGY  OF   INEBRIETY.  181 

pattern,  and  was  very  unreliable  about  the  trigger.  The 
shooting  was  claimed  to  be  an  accident.  The  young  man 
was  no  doubt  in  a  state  of  more  or  less  muscular  incapacity. 
Testimony  was  given  that  in  handling  a  pistol  by  a  person 
drunk,  it  would  more  likely  to  be  accidentally  discharged 
than  it  would  be  in  the  hands  of  the  same  person  when 
sober.  Although  in  this  case  other  facts  pointed  to  mur- 
der, yet  such  a  plea  in  defense  might  have  been  perfectly 
good  and  proper. 

A  drunken  man  cannot  dance.  It  does  not  require  a 
very  considerable  degree  of  intoxication  to  disable  a  person 
for  dancing.  Anything  which  requires  a  community  of 
action  amongst  a  number  of  muscles — an3'tliing  which  is  in 
the  line  of  auxiliary  aid,  or  help  in  muscular  actions,  is  an 
utter  impossibility  for  the  individual  who  is  intoxicated. 
Yet,  if  there  is  a  person  in  the  world  who  thinks  he  can 
exhibit  the  consummation  of  grace,  ease,  and  eclat  in  danc- 
ing, it  is  the  man  who  is  drunk. 

In  consequence  of  the  inequality  of  alcoliolic  paralysis, 
even  on  the  muscular  system  itself,  the  really  drunken  indi- 
vidual moves  as  though  he  was  about  to  fall  in  pieces.  The 
inebriate  dancer  would  probably  miOve  off  in  sections  or 
separate  parts,  were  it  not  that  his  physical  body  is  securely 
fastened  togetiier  in  spite  of  himself.  The  want  of  l)armony 
between  mind  and  body,  often  present,  also,  no  doubt,  dis- 
ables the  drunken  dancer.  Sometimes  the  muscles  act 
tolerably  well  in  the  intoxicated  individual,  while  his  mind 
and  will  may  be  in  a  state  of  sad  confusion.  At  other  times 
hi5  mind  may  be  fairly  clear,  while  he  is  limp  and  helpless 
on  his  legs. 

The  musician  and  the  actor  likewise  fail  in  the  exercise 
of  their  callings  when  intoxicated.  The  actor  is  totally 
unable  to  depict  character  by  facial  expression.  The 
muscles  of  his  countenance  are  withdrawn  from  voluntary 
control.  The  feature  he  wants  to  supply  will  not  come  at 
his  bidding — it  is  something  else,  something  quite  different, 


182  DISEASES    OF   INEBRIETY. 

and  yet  he  is  not  conscious  of  the  fact.  He  is  deceived  by 
the  power  of  alcohol,  and  resents  the  obtuseness  and  unfair- 
ness of  his  critics. 

The  effects  of  alcohol  upon  the  body  of  even  the  casual 
drinker  are  always  those  of  a  traitor — they  always  betray. 
The  steadiness  and  tone  of  nerve  which  seem  to  follow  from 
its  use  aie  only  indications  of  paralysis  and  insensibility 
which,  deceiving  the  mind,  lure  the  unwary  drinker  into 
danger  and  disgrace. 

The  late  Dr.  Jewell  gives  the  following  description, 
which  applies  in  many  cases  of  inebriety  :  "  There  is  a  real, 
pervasive  nutritive  lesion  of  nerve  structure  in  neurasthenia. 
Waste  has  morbidly  preponderated  over  repair.  The  nerv- 
ous system  becomes  lean.  This  involves,  necessarily,  loss  of 
power  and  undue  sensitiveness  or  "shakiness  "  of  the  nerv- 
ous system.  It  is  more  easily  excited  than  when  healthy, 
and  the  excitement  when  once  produced  radiates  farther, 
and  endures  longer,  than  in  health.  This  state  or  physical 
condition  of  the  nerve  structures  differs  in  degree  in  various 
cases  or  at  different  times  in  the  same  case,  from  a  very 
slight  exhaustion  to  that  which  is  the  most  profound.  It 
may  extend  to  the  whole  nervous  system  or  to  only  a  small 
part  of  it,  or,  if  to  all  parts,  unequally  so  to  different  parts. 
It  may  be  in  part  hereditary,  or  it  maybe  acquired.  It  may 
affect  chiefly  the  bodily  functions,  or  it  may  affect  chiefly 
the  mental  functions,  as  in  some  cases  of  melancholia,  or  it 
may  involve  both  at  the  same  time  in  varying  ways  and  pro- 
portions, as  often  happens. 

There  is  another  condition  of  neurasthenia  which  I  wish 
tp  place  distinctly  before  you.  It  consists  in  a  morbidly 
fluctuating  blood-supply  to  tlie  affected  parts  of  the  nervous 
system.  The  nutritive  lesion  described  seems  always  to 
involve  an  unsteady  circulation  of  blood  in  the  part  which 
has  suffered.  Especially  is  the  blood-supply  likely  to 
fluctuate  rapidly,  from  a  too  free  and  tumultuous  supply  for 
healthy  nutrition,  down  to  a  partial  anaemia.     Nutrition  in 


PATHOLOGY    OF    INEBRIETY.  183 

the  part  in  question  is  therefore  irregular  and  unreliable. 
Hence  nervous  action  is  unsteady  and  unreliable.  The 
condition  of  the  walls  of  the  blood-vessels  themselves,  and 
of  the  local  vaso-motor  mechanisms  which  control  them,  in 
the  diseased  nervous  centres,  is  much  the  same  as  that  of 
the  worn  nerve  elements  in  the  midst  of  which  they  are. 
The  local  vaso-motor  apparatus  become  worn  and  ex- 
hausted, and  the  muscular  walls  of  ttie  vessels  in  the  seat 
of  disease  lose  their  tonus  in  a  measure,  and  give  way 
before  any  increase  in  the  blood-pressure  with  abnormal 
ease,  and  this  is  one  of  the  cliief  conditions  of  a  fluctuating 
circulation  of  blood  in  the  diseased  nervous  centres.  When 
it  is  known  how  sensitive  are  the  higher  nervous  centres  to 
changes  in  the  pressure  and  quantity  of  the  blood  circulating 
in  them,  it  will  not  be  difficult  to  understand  how  rapid  and 
extreme  fluctuations  in  blood-suppl}'  may  give  rise  to  many 
symptoms,  varying  according  to  the  function  of  the  part 
which  is  the  seat  of  the  disorder. 


CHAPTER  XX. 

PATHOLOGICAL   CHANGES   IN   ALCOHOLIC    INEBRIETY. 

If  we  consider  the  serum  of  the  blood  in  the  habitual 
drunkard  as  an  alcoholized  fluid,  and  that  alcohol  existing 
in  a  certain  percentage  in  the  serum  acts  not  only  upon  the 
serum  of  the  blood  but  also  upon  its  anatomical  elements, 
we  have  a  condition  that  modifies  nutrition,  producing  met- 
amorphosis and  degeneration  of  tissue.  If,  in  connection 
with  this,  we  add  the  fact  that  alcohol,  J>er  se,  is  anarcothie 
irritant,  producing  modification  as  well  as  degeneration  of 
tissue  independent  of  blood  changes,  we  have  an  additional 
reason  to  regard  alcohol  as  a  disease-producing  agent. 

We  have,  then,  to  study  the  pathological  effects  produced 
by  alcohol  on  the  blood  from  two  standpoints  : 

First. — As  to  its  effect  on  the  blood  itself. 

Second. — The  direct  effect  of  the  alcohol  in  the  alcohol- 
ized blood  or  serum  upon  the  tissues  of  the  body. 

It  would  be  of  interest  to  determine  to  what  extent  the 
serum  of  the  blood  can  take  up  alcohol.  That  it  does  so, 
in  common  with  the  other  fluids  of  the  body,  there  can  be 
no  doubt.  Blood  taken  from  an  habitual  drunkard,  and 
exposed  to  heat,  will  give  off  the  fumes  of  alcohol.  At 
autopsies  on  drunkards,  the  fluid  in  the  ventricles  of  the 
brain  has  been  ignited  with  a  match. 

There  is  good  reason  to  warrant  the  conclusion  that  not 
only  the  serum  of  the  blood,  but  also  the  fluid  of  the  ventri- 
cles and  the  cerebro-spinal  fluid,  in  the  case  of  habitual 
drunkards,  contain  alcohol  to  a  greater  or  less  extent,  in 
some  cases  probably  as  much  as  is  compatible  with  life.     A 

185 


186  DISEASES    OF   INEBRIETY. 

series  of  chemical  analyses,  to  determine  the  average  per- 
centage of  alcohol  in  the  blood  of  habitual  drunkards, 
would  be  of  extreme  interest.  The  blood  in  such  a  con- 
dition has  not  only  its  nutritive  qualities  very  much  impaired 
and  its  oxygenation  and  circulation  retarded,  but  as  a  build- 
er up  of  tissue  it  must  be  very  inferior  to  normal  blood  ; 
in  fact,  it  is  a  disintegrator  of  tissue.  The  urine  of  the  habit- 
ual drunkard  contains  a  certain  percentage  of  alcohol.  The 
application  of  heat  or  the  proper  chemical  tests  for  alcohol, 
if  applied,  prove  this.  Indeed,  if  we  test  tlie  urine  of  an 
abstainer  within  a  reasonable  time  after  he  has  taken  alco- 
hol, the  chromic  acid  test  will  show  the  characteristic  reac- 
tion. The  effort  to  prove  that  the  milk  of  nursing  mothers 
using  beer  or  other  alcoholic  beverages  did  not  contain 
alcohol,  has  resulted  in  failure.  The  toxic  effect  on  the 
infant  is  shown  in  the  moderate  alcohol  coma  it  experiences 
after  nursing,  and  where  the  mother  was  intoxicated,  the 
convulsions  that  ensued. 

The  experience  of  M.  Lallemand,  Duroy,  and  Perrin 
seemed  to  demonstrate  that  alcohol  received  into  the  body 
was  eliminated  by  the  lungs,  the  kidneys,  and  the  skin,  com- 
pletely and  as  alcohol,  and  that  if  it  was  retained  in  the 
tissues  it  was  not  transformed.  The  experiments  of  Anstie, 
on  the  other  hand,  disprove  this.  "While  a  certain  propor- 
tion of  the  alcohol  injested  is  excreted  by  the  lungs, 
kidneys,  and  skin,  a  certain  proportion  is  broken  up  in  the 
blood  and  transformed  into  some  otlier  substance,  prob- 
ably aldehyde,"  just  as  aldehyde  shortly  after  its  adminis- 
tration is  transformed  in  the  blood  into  acetic  acid.  But 
this  does  not  weaken  the  practical  fact  that  alcohol  is 
present  in  all  the  fluids  of  the  body,  passes  through  all 
the  excretory  organs,  acts  directly  upon  the  nervous 
system  and  other  tissues  of  the  body,  producing  its  delete- 
rious effects  either  as  alcohol  or  some  transformation  of  it 
equally  pernicious.  The  degeneration  and  alteration  of 
tissue  in  chronic  alcoholism  is  due  to  the  following  causes  : 


PATHOLOGICAL    CHANGES    IN    ALCOHOLIC    INEBRIETY.      187 

First.  An  impoverished,  alcoliolized  blood,  imperfect 
in  its  oxygenation  and  retarded  in  its  circulation,  and,  con- 
sequently, producing  mal-nutrition. 

Second.  The  direct  irritating  effects  of  alcohol  contained 
in  said  blood. 

Third.  Tlie  degenerating  effects  of  alcohol  on  the  nerv- 
ous centers,  producing  vaso-motor  paralysis  and  impaired 
reflex  action. 

The  latter  is  regarded  by  some  writers  as  the  primal 
and  most  potent  cause  of  general  alcoholic  degeneration. 
The  principal  tissue  changes  in  chronic  alcoholism  are  falty, 
fibroid,  and  atrophic. 

The  most  marked  examples  of  alcoholic  fibrosis  are 
found  in  the  lungs,  kidney,  and  liver. 

In  the  lungs,  as  alcoholic  phthisis,  a  chronic  interstitial 
pneumonia  ;  in  the  liver  is  cirrhosed,  gin,  or  hobnail  liver  ; 
in  the  kidney  as  cirrhotic,  hard,  or  contracted  kidney. 
These  fibroid  changes  are  slow,  may  take  years  to  form, 
but  they  are  rapid  in  the  latter  stage.  In  syphilis  we  may 
resolve  a  gumma  or  modify  the  lesions  of  the  tertiary  stage. 
In  pulmonary  tuberculosis  we  may  be  fortunate  enough  to 
secure  cicatrization  of  cavities,  or  hold  the  disease  in  check; 
but  the  lesions  of  chronic  alcoholism  are  progressive,  and, 
when  once  fully  established,  irremediable,  whether  in  the 
lungs,  kidney,  or  liver. 

The  effect  of  chronic  alcoholism  on  the  generative  func- 
tions in  both  sexes  is  instructive  and  interesting. 

"  Lippich  has  demonstrated  that  alcoholized  marriages 
1  roduce  two-thirds  less  children  than  among  those  who 
were  lemperate.  There  can  be  no  doubt  that  alcoholism 
affects  the  generative  function  of  both  sexes.  The  testicles 
undergo  degeneration  in  alcoholized  persons.  The  sper- 
matic fluid  shows  this  in  the  well  marked  changes  it 
exhibits,  robbing  of  the  vitality  indispensible  to  concep- 
tion." 

"The  alcoholic  cachexia   after  it  has  attained  sufficient 


188  DISEASES   OP    INEBRIETY. 

intensity,  will  produce  this,  although  the  organs  themselves 
may  not  be  diseased.  Many  examples  of  women  are  noted 
who  have  had  children  by  their  first  marriage  whose  subse- 
quent union  was  barren  with  an  alcoholized  husband,  and 
also  the  reverse.  Women  may  become  sterile  by  altera- 
tions of  the  ovaries  and  matrix,  and  abort  before  maternity. 
From  this  point  of  view  alcoliolism  is  a  more  serious 
trouble  in  the  mother  than  in  the  father." 

Drs.  Mairet  and  Combernal  recently  presented  some 
experiments  on  the  hereditary  influence  of  alcohol  before 
the  Academy  of  Sciences  of  Paris. 

A  healthy  bitch  was  made  a  chronic  alcoholic,  and  gave 
birth  to  twelve  puppies  ;  two  were  still-born,  three  died  b}'^ 
accident,  and  the  remaining  seven  died  of  epileptic  attacks, 
enteritis,  pulmonary  and  peritoneal  tuberculosis.  The 
lesions  found  at  the  post-mortems  were  thickening  of  the 
bones,  fatty  degeneration  of  the  liver,  adhesion  of  the  dura- 
mater,  and  other  marked  alcoholic  changes. 

A  strong  bitch  was  kept  intoxicated  on  absinthe  the  last 
three  weeks  of  gestation.  Six  puppies  were  born  ;  three 
died  at  birth  ;  two  were  of  defective  intelligence  ;  one  grew 
up,  but  was  defective  in  intelligence  and  nervous  organiza- 
tion. This  one  was  coupled  with  a  healthy  dog  ;  of  this 
union  three  puppies  were  born  ;  one  died  of  marasmus, 
the  other  two  were  congenitally  defective,  having  atrophy 
of  hind  legs.  One  of  the  conclusions  drawn  was  that  the 
degeneration  from  alcohol  was  more  prominent  in  the 
second  generation  than  the  first  ;  also  that  alcohol  used  by 
the  mother  always  produced  defective  offspring. 

A  point  of  interest  in  this  connection  is  the  etiology  of 
dipsomania.  The  best  authorities  now  agree  that,  while 
exceptionally  dipsomania  may  arise  from  traumatism  or 
alcoholism,  the  great  majority  of  cases  are  traced  to  an 
insane  or  intemperate  parent  or  parents.  It  is  a  hereditary, 
not  an  acquired  neurosis. 

It    will    be    of  interest  to  record  further  the  results  of 


PATHOLOGICAL   CHANGES    IN    ALCOHOLIC   INEBKIETT.      189 

chronic  alcoholism  in  the  lower  animals,  produced  by 
experimenters  with  the  view  of  determining  the  pathologi- 
cal lesions  of  alcohol.  And  none  have  been  more  zealous 
than  the  French  in  this  direction  ;  and  of  these  investigators 
none  more  prominent  or  painstaking  than  M,  Magnan, 

"  M.  Tardieu  has  found  meningeal  haemorrhages  in  per- 
sons dying  in  a  state  of  intoxication.  These  are  less  fre- 
quent in  animals,  and  this  is  the  reason  why  pachymenin- 
gitis due  to  the  prolonged  action  of  alcohol  is  rarer  in  ani- 
mals than  in  man." 

Magnan. — "That  in  dogs,  even  at  the  end  of  two  months 
of  alcoholic  poisoning,  the  liver  undergoes  fatty  degenera- 
tion. A  microscopic  section  shows  the  cells  have  lost  form, 
are  swollen,  round,  infiltrated  with  granules  and  drops  of 
fat." 

M.  Pupier  notes  the  effect  on  a  fowl  to  which  absinthe 
had  been  given  as  a  drink  ten  months.  "  The  liver  is  hard, 
resistant,  lessened  in  volume,  has  irregularities  on  its  two 
surfaces,  numerous  whitish  depressions,  the  intermediate 
parts  of  a  reddish  brown  color.  The  microscope  shows 
dilatation  of  vessels  at  periphery  of  lobules,  filled  with  gran- 
ules ;  extreme  compression  and  degeneration  of  hepatic 
cells." 

In  another  experiment  a  fowl  was  subjected  to  the 
action  of  red  wine  for  ten  months.  "  The  liver  is  of  a  clear 
yellow  color,  soft,  pasty,  and  oils  the  blade  of  the  scalpel. 
Microscope  shows  cells  enlarged  and  rounder  than  normal, 
filled  with  granules  resembling  those  in  parencliymatous 
inflammation  at  its  beginning  ;  here  and  there  large  fat 
drops." 

A  fowl  was  given  white  wine  under  similar  conditions. 
"The  liver  is  of  good  color,  but  is  shriveled  on  its  lower 
surface  and  borders.  Microscope  shows  dilatatiorfi  of  vessels, 
which  appear  three  or  four  times  the  normal  size  when 
compared  vvitli  the  cells  which  have  undergone  atrophic 
degeneration.     A  rabbit    was    subjected    to    alcohol.     The 


190  DISEASES   OF   INEBRIETY. 

liver  shows  nothing  as  regards  capillary  net-work  ;  the  cells 
are  altered  and  contain  two  or  three  nuclei  ;  around  bile 
ducts  there  is  an  increase  of  connective-tissue  nuclei.  M. 
Pupier  concludes  that  absinthe  affects  primarily  the  stroma 
without  producing  new  connective  tissue  or  sclerosis  of 
walls  of  vessels.  This  marked  new  growth  has  not  been  con- 
firmed. As  for  red  and  white  wine  and  alcohol,  their 
injurious  effect  is  seen  rather  in  the  plasma  and  hepatic 
parenchyma," 

Alcohol  would  seem  to  produce  hepatic  steatosis,  but 
not  to  the  exclusion  of  sclerosis. 

A  prolonged  period  of  alcoholic  intoxication,  and  conse- 
quent irritation,  might  provoke  sclerosis.  In  the  same  ani- 
mal, with  fatty  degeneration  of  liver,  are  found  irritative 
lesions,  such  as  pachymeningitis,  sclerosis  of  posterior  col- 
umns of  spinal  cord,  thickening  and  opacity  of  arachnoid 
and  pia  mater,  milky  patches  in  pericardium — all  these  at 
the  same  time. 

"The  kidneys,  like  the  liver,  undergo  beginning  fatty 
degeneration.  The  surface  is  smooth  and  even  ;  the 
cortical  substance  and  prolongation  between  the  pyramids 
of  Malphigi  show  a  well-marked  yellowish  tint,  with  small 
striations  of  a  deeper  color.  The  microscope  shows  tubuli, 
slightly  swollen,  cloudy,  filled  with  granular  and  fatty 
epithelium." 

M.  Ruge  mentions  adhesion  of  capsule  to  renal  substance 
in  four  cases  ;  in  three  cases  fatty  degeneration  of  the  heart. 
Magnan  has  seen  traces  of  pericarditis  :  "  The  coats  of  the 
stomach  in  dogs  who  take  alcohol  mixed  with  food  are  not 
^ensibly  thickened  ;  but  the  mucous  membrane  is  injected, 
rarely  ulcerated." 

When  alcohol  is  taken  without  food,  and  directly  injected 
by  oesophageal  tube  or  by  fistula,  traces  of  violent  gastritis 
are  seen  ;  in  one  case  the  stomach  was  shriveled  and  thick- 
ened, and  the  surface  of  the  reddish-brown  mucous  mem- 
brane was  H-ned  with  a  layer  of  thick,  sticky,  glairy  mucus, 


PATHOLOGICAL    CHANGES    IN    ALCOHOLIC    INEBRIETY,      191 

Streaked  with  blood.  On  cleansing  with  a  stream  of  water, 
small  ulcerations  with  irregular  borders  were  seen  ;  in  some 
places  cicatrices  appeared  as  irregular  grayish  plates.  In 
the  mucus  were  found  infiltrations  of  blood,  some  in  layers, 
others  in  small  spots.  In  the  same  dog,  the  cord  is  not  in- 
jected and  appears  normal  ;  a  grayish  tint  is  seen  on  the 
posterior  columns,  more  marked  on  lower  third,  where  it 
has  the  form  of  a  triangle  with  the  base  directed  backwards 
on  each  side  of  the  posterior  median  fissure  ;  in  the  same 
locality  a  slight  grayish  tint  in  the  anterior  columns  on 
each  side  of  commissure  ;  Magan  lias  noted  the  same  con- 
dition in  a  man  where  chronic  alcoholism  terminated  in 
general  paralysis. 

Kremiansky,  in  dogs  who  were  given  alcohol  four  weeks, 
noticed  pachymeningitis. 

M.  Neumann  observed  the  same  fact,  but  also  that  it 
did  not  exist  sometimes  in  a  more  prolonged  use  of  alcohol. 
Magnan  found  slight  infiltration  and  slight  thickening  of 
arachnoid  and  pia  matei',  but  no  false  membranes  of  dura 
mater.  Others,  slight  dilatation  of  vessels  of  dura  or 
simple  injection  or  oedema  of  pia. 

This  diversity  is  explained  by  Magnan  as  due  in  some 
cases  to  a  meningeal  haemorrhage  during  drunkenness,  a 
haemorrhagic  pachymeningitis  ;  but  while  this  accounts  for 
the  existence  of  new  membranes  in  some  dogs,  Magnan 
asserts  "  that  pachymeningitis  may  come  on  without  pre- 
existing haemorrhage  in  certain  nervous  affections  and 
chronic  alcoholism." 

We  have  thus  quoted  extensively  from  these  French 
experimenters  that  others  may  be  encouraged  to  follow 
similar  researches  with  regard  to  the  "  pathological  effects 
of  alcohol  "  in  animals,  with  the  advantage  of  improved 
pathological  knowledge  and  modern  appliances  ;  for  these 
investigations  demonstrate  not  only  that  researches  as  to 
the  effects  of  alcohol  can  be  satisfactorily  conducted  in  the 
lower  animals,  but  they  also    corroborate  what  has    been 


192  DISEASES   OF   INEBRIETY. 

demonstrated  to  be  the  effects  of  clironic  alcoholism  on  pro- 
creation in  the  human  species,  as  well  as  its  other  patholog- 
ical effects. 

Alcohol  acts  not  only  indirectly  through  the  blood  as  an 
irritant,  provoking  fibrosis  or  other  tissue  changes,  "but  on 
tlie  alimentary  canal,  particularly  the  stomach.  The  local 
effects  of  habitual  doses  of  concentrated  alcohol  are  seen  in 
the  permanent  congestion  of  the  blood  vessels,  exaggerated 
or  vitiated  secretions  from  tiie  gastric  glands,  and  ulti- 
mately a  degenerative  change  in  the  structure  of  the  sub- 
mucous tissues,  which  consists  in  the  disappearance  of 
characteristic  secreting  structures  and  hypertrophic  exagger- 
ation of  fibrous  tissues." 

The  effect  of  alcohol  upon  muscular  or  other  tissue,  pro- 
ducing fatty  degeneration,  is  similar  in  this  respect  to  the 
action  of  phosphorus,  arsenic,  or  other  poison.  Fatty  de- 
generations of  the  pancreas  from  alcoholism  shows  "  the 
glandular  parenchyma  has  partially  or  entirely  disappeared  ; 
_it  may  be  replaced  by  adipose  tissue,  which  is  developed  in 
the  fibrous  stroma  of  the  organ  around  its  vessels  and 
glandular  ducts."  In  some  instances  the  acini  or  charac- 
teristic gland  structure  is  lost  entirely  and  replaced  with 
fatty  tissue. 

But  the  most  marked  evidence  of  the  deteriorating 
effects  of  alcohol  is  seen  in  its  action  on  the  nervous  system. 
"It  is  clear  that  the  nervous  centers,  independently  of  the 
ill  effects  on  their  nutrition  of  the  blood  changes,  have  a 
certain  chemical  attraction  for  alcohol,  which  accordingly 
is  found  in  their  tissue. 

"The  characteristic  changes  which  have  been  observed 
in  the  brain,  medulla  oblongata,  etc.,  of  confirmed  drinkers, 
consists  essentially  of  a  peculiar  atrophic  modification  by 
which  the  true  elements  of  nervous  tissue  are  partially  re- 
moved ;  the  total  mass  of  nervous  matter  wastes,  serous 
fluid  is  effused  into  the  ventricles  and  the  arachnoid,  while 
simultaneously  there  is   a  marked   development  of   fibrous 


PATHOLOGICAL    CHANGES    IN    ALCOHOLIC    INEBRIETY.      103 

tissue,  granular  fat,  and  other  elements   which    belong  to   a 
low  order  of  vitalized  products." 

From  these  conditions  arise  vaso-motor  paralysis,  with 
all  the  results  that  follow  a  defective  supply  of  blood  and 
an  impaired  circulation,  tending  to  local  stasis.  Moreover, 
if  we  exclude  traumatism,  there  is  not  any  disease  of  the 
nervous  system  resulting  from  other  causes  than  alcoholism, 
at  least  with  few  exceptions,  that  alcohol  cannot  produce — 
alcoholic  neuritis,  alcoholic  anaesthesia,  general  paralysis, 
serous  apoplexy,  etc.,  and  those  cerebral  conditions  from 
which  arise  the  acute  and  chronic  forms  of  mental  derange- 
ment. The  nerves  of  special  sense  are  not  exempt.  "  The 
abuse  of  alcoholic  stimulants  has  been  said  to  be  the  cause 
of  amaurosis,  and,  as  a  proof  of  this,  tlie  fact  has  been 
adduced  that  the  affection  has  been  arrested,  or  even  cured, 
by  completely  giving  up  the  habit  of  drinking.  Tliis  much 
is  certain,  that  amblyopia  occurs  in  great  misproportiun 
among  habitual  drinkers.  It  is  generally  first  seen  as  night- 
blindness,  but  soon  becomes  constant,  and  gray  atrophy  of 
the  nerve  is  recognized  by  the  ophthalmoscope."  (Pagen- 
stecher.) 

"  One  point  of  interest  in  this  connection,  relating  to  the 
action  of  alcohol  on  the  nervous  system,  is  the  theory 
advanced  by  writers  on  this  subject,  and  it  is  a  very  plaus- 
ible one  :  that  the  degeneration  of  all  tissue  in  cases  of 
alcoholism  is  due  primarily  to  the  action  of  alcohol  on  the 
nervous  centers,  and  through  these,  by  vaso-motor  disturb- 
ance or  impaired  reflex  action,  upon  the  organs  or  tissues 
which  these  nerve  centers,  or  vessels  influenced  by  them, 
supply."  But  it  would  seem,  while  regarding  this  as  the 
prime  cause  of  alcoholic  degeneration,  we  could  not  ignore 
the  fact  that  the  blood  itself  was  a  chronic  alcoholism  much 
deteriorated  as  to  its  quality  and  retarded  as  to  its  circula- 
tion, and,  moreovei-,  tiiat  it  contained  a  chemical  irritant. 
The  limits  of  this  paper  will  not  permit  us  to  consider  in 
detail  all  the  pathological  changes  due  to  alcohol.     It  affects 


194  DISEASES   OF   INEBRIETY. 

all    the    tissues    of    the    body  ;    even    the     bones    are    not 
exempt. 

We  have  therefore  generalized  our  statements  and  taken 
a  view  over  the  whole  field,  rather  than  endeavored  to  carry 
out  and  elaborate  any  special  line  of  thought.  Our  object 
has  been  to  demonstrate  that  there  is  abundant  material  for 
the  pathologist  and  the  microscopist  to  investigate,  and  a 
neglected  but  nevertheless  a  rich  field  for  medical  research. 
How  little  progress  has  been  made  in  the  study  of  the  path- 
ology of  chronic  alcoholism  and  the  diseases  incident  to  alco- 
holism. 

A  general  principle  may  be  laid  down  that,  whatever 
tends  to  innutrition  aims  directly  at  that  strength  and  bal- 
ance of  its  forces,  that  coordination,  so  to  speak,  between  its 
peripheral  and  central  portions,  that  it  is  needful  for  the 
equable  discharge  of  its  multitudinous  functions.  Innutri- 
tion, by  lowering  the  vitality  of  the  brain-cells,  and  dimin- 
ishing the  store  of  power  held  by  the  central  ganglia  from 
the  steady  and  well-timed  responses  to  all  the  demands 
upon  them,  into  spasmodic,  irregular,  and  insufficient  sup- 
plies of  the  force  which  it  is  tiieir  province  to  furnish.  But 
alcohol  especially  promotes  innutrition,  and  the  very  stimu- 
lation which  it  produces  is  the  surest  evidence  of  its  drain 
upon  those  reserve  forces,  that  exubei-ance  of  tlie  central 
nervous  fund,  that  wealth  of  power  which  is  indispensable  to 
the  maintenance  of  the  full  vigor,  of  the  constitution  during 
those  brief  and  rare  occasions  when  unforeseen  circum- 
stances shall  make  unusual  demands  upon  them. 

Nor  is  this  exhaustion  and  innutrition  all  the  evil  which 
alcohol  works  in  the  constitution.  The  blood  and  secre- 
tions are  vitiated  and  loaded  with  material  foreign  to  their 
normal  constitution,  and  there  is  a  universal  departure 
from  that  almost  infinite  delicacy  of  balance,  resiliency  of 
the  organization,  which  in  the  natural  healthy  state  charac- 
terizes its  various  portions,  to  say  nothing  of  that  depri- 
vation of  the  higher  spiritual  nature  which  is  the  inevitable 


PATHOLOGICAL   CHANGES    IN   ALCOHOLIC    INEBRIETY.     195 

concomitant  of  the  habitual  deviation  from  natural 
metliocls  which  is  forced  upon  it.  Nor  is  this  all  of  the 
evil.  How  unreasonable  it  is  to  suppose  that  children 
begotten  of  a  parent  during  such  exhaustion  of  the  gangli- 
onic force — during  such  prolonged  vitiation  of  the  blood 
and  secretions  and  the  perversion  of  the  intellectual  and 
moral  forces — should  not  carry  in  their  physical  and  spirit- 
ual natures  evidence  of  the  outrage  done  to  natural  laws  ! 


CHAPTER  XXI. 

GENERAL  CONSIDERATIONS  OF  TREATMENT,   PPfOGNOSES, 
RESULTS,  ETC. 

Four  conditions  of  cure  must  be  observed.  The  first 
condition  of  cure  and  reformation  is  abstinence.  The 
patient  is  being  poisoned  and  the  poisoning  must  be  stopped. 
Were  it  an  arsenic  instead  of  an  alcohol  no  one  would  dis- 
pute this  ;  so  long  as  the  drinking  of  intoxicants  is  indulged 
in,  so  long  will  the  bodily,  mental,  and  moral  mischief  be 
intensified  and  made  permanent.  Abstinence  must  be 
absolute,  and  on  no  plea  of  fashion,  of  physic,  or  of  religion, 
ought  the  smallest  quantity  of  an  intoxicant  be  put  to  the 
lips  of  the  alcoholic  slave.  Alcohol  is  a  material  chemical 
narcotic  poison,  and  a  mere  slip  fias,  even  in  the  most  sol- 
emn circumstances,  been  known  to  relight  in  the  fiercest 
intensity  the  drink  crave  which  for  a  long  period  of  years 
had  been  dormant  and  unfelt.  The  second  condition  of 
cure  is  to  ascertain  the  predisposing  and  exciting  causes  of 
inebriety,  and  to  endeavor  to  remove  these  causes,  which 
may  lie  in  some  remote  or  deep-seated  physical  ailment. 
The  third  condition  of  cure  is  to  restore  the  physical  and 
mental  tone.  This  can  be  done  by  appropriate  medical 
treatment,  by  fresh  air  and  exercise,  by  nourishing  and 
digestible  food  given  to  reconstruct  healthy  bodily  tissue 
and  brain  cell,  aided  by  intellectual,  educational,  and  other 
influences.  Nowhere  can  these  conditions  of  cure  be  so 
effectually  carried  out  as  in  an  asylum  where  the  unfortun- 
ate victim  of  drink  is  placed  in  quarantine,  treated  with 
suitable  remedies  until  the  alcohol  is  removed  from  his  sys- 

197 


198  DISEASES   OF   INEBRIETY. 

tem,  then  surrounded  by  elevating  influences,  fed  with  a 
nourishing  and  suitable  diet,  and  supplied  with  skillful 
medical  treatment.  His  brain  and  nervous  system  will 
then  be  gradually  restored  to  its  normal  condition,  and, 
after  a  period  of  from  six  to  twelve  months  in  most  cases, 
he  will  be  so  far  recovered  as  to  be  able  to  return  to  his 
usual  avocation  and  successfully  resist  his  craving  for 
drink. 

In  the  cttre  of  inebriety  there  is  probably  more  agitation 
and  interest  than  ever  before.  The  efforts  of  societies  and 
parties,  of  the  pulpit  and  rostrum,  with  the  increasing  books 
and  papers  from  the  press,  have  never  been  more  active  than 
to-day.  Yet  reports  show  that  inebriety  is  increasing,  and 
that  more  spirits  are  made  and  consumed  every  year. 

All  the  temperance  efforts  and  legal  means  for  the  cure 
and  prevention  of  inebriety  are  based  on  the  theory  that  it  is 
a  moral  disorder  which  the  victim  can  control  at  will,  or  a 
wicked  habit  that  he  can  continue  or  put  away  at  his  own 
pleasure.  This  theory  of  inebriety  is  theoretical,  and 
embodies  the  same  error  which  follows  every  new  advance 
of  thought,  namely,  explaining  all  human  action  from  some 
moral  or  theological  standpoint.  Thus  the  phenomenon  of 
insanity  was  explained  as  a  possession  of  tiie  Devil,  and  the 
victims  were  supposed  to  enter  into  a  compact  with  evil 
spirits,  voluntarily.  The  remedy  was  severe  punishment. 
Public  attention  was  occupied  for  ages  in  persecuting  and 
punishing  the  insane  and  epileptics  on  this  tiieory  of  the 
causation.  Law,  religion,  government,  and  public  senti- 
ment, all  failed  in  the  cure  and  prevention  by  this  means, 
and  these  diseases  went  on  unchecked,  simply  because  the 
real  causes  were  unknown. 

Inebriety  is  regarded  in  the  same  way  as  wickedness,  and 
the  same  means  are  urged  as  a  remedy.  Over  five  liun- 
dred  thousand  inebriates  were  sent  to  jail  in  iSgi.and  pun- 
ished as  willful  and  voluntary  drunkards.  Armies  of 
moralists  and  temperance  people  are  pledging  and  praying 


GENERAL   CONSIDERATIONS   OF   TREATMENT.  199 

the  inebriate  to  stop  drinking,  and  exercise  his  will,  and  be 
temperate  and  well  again. 

Yet  all  such  efforts  fail,  and  often  tend  to  increase  the 
very  condition  which  they  seek  to  remedy.  They  fail 
because  they  are  based  on  a  false  assumption  of  the  causes, 
and  not  on  any  accurate  study  of  tlie  history  or  real  con- 
dition of  the  patient.  A  new  era  is  dawning  for  the  inebri- 
ate. His  diseased  condition,  and  the  need  of  special 
medical  care  in  special  surroundings,  is  a  truth  that  is 
spreadingslowly  and  surely  in  all  directions.  Not  faraway 
in  the  future  inebriety  will  be  regarded  as  small-pox  cases 
are  now  in  every  community.  The  inebriate  will  be  forced 
to  go  into  quarantine  and  be  treated  for  his  malady  until 
he  recovers.  The  delusion  that  he  can  stop  at  will,  because 
he  says  so,  will  pass  away.  Public  sentiment  will  not  per- 
mit the  victim  to  grow  into  chronic  stages  ;  the  arhiy  of 
moderate  and  periodic  drinkers  will  be  forced  to  disappear, 
and  the  saloons  which  they  have  supported  will  close  in 
obedience  to  a  higher  law  than  any  prohibition  sentiment. 

Public  sentiment  will  realize  that  every  inebriate  is  not 
only  diseased,  but  dangerous  to  society,  to  himself,  and  all 
his  surroundings,  and  demand  legal  guardianship  and  re- 
striction of  personal  liberty  until  he  recovers.  When  these 
poor  victims  realize  that  society  will  not  tolerate  their 
presence  or  allow  them  personal  liberty  in  this  state,  they 
will  seek  help  and  aid  before  they  reacli  extreme  stages. 

This  is  the  teaching  of  all  modern  science, — to  check  the 
disease  at  the  beginning,  to  seize  the  poor  waif  on  the  street 
and  the  rich  man's  son,  who  are  just  at  the  beginning  of 
inebriety,  and  force  them  into  conditions  of  health  and  sobri- 
ety, to  save  the  one  from  becoming  a  prey  on  society  and  a 
burden  to  the  producer  and  tax-payer,  and  the  other  from 
destroying  society  and  himself  and  leaving  a  tide  of  misery 
and  sorrow  that  will  continue  long  after.  When  society 
shall  realize  and  act  on  these  facts,  the  great  centers  of  pau- 
perism and   criminality  will   be    broken    up.     This  will  be 


200  DISEASES    OF   INEBRIETY. 

accomplished  by  the  establishment  of  work-house  hospitals, 
where  the  inebriate  can  be  treated  and  restrained.  Such 
places  must  be  located  in  the  country,  removed  from  large 
cities  and  towns,  and  conducted  on  a  military  basis.  They 
must  have  all  the  best  appliances  and  remedial  means  to 
build  up  and  restore  the  debilitated  victim.  They  should 
be  military  training  hospitals,  where  all  the  surroundings 
are  under  the  exact  care  of  the  physician,  and  every  condi- 
tion of  life  is  regulated  with  steady  uniformity. 

Besides  the  medicinal  and  hygienic  treatment,  there 
should  be  educational  and  industrial  training,  and  each  one 
should  be 'employed,  both  in  body  and  mind,  every  day. 
He  should  be  placed  in  a  condition  for  the  best  culture  and 
building  up  of  the  entire  man.  Every  defect  of  body  and 
mind  should  be  antagonized  and  remedied  as  far  as  possible. 
Each  case  sliould  be  an  object  of  study  to  ascertain  the  real 
state  and  the  means  to  strengthen  and  improve  it.  These 
hospitals  should  be  built  and  conducted  entirely  from  the 
license  fund  or  the  taxes  on  the  sale  of  spirits.  They  should, 
in  a  large  measure,  be  self-supporting  from  the  labor  of  the 
inmates,  and  independent  of  the  tax-payers.  These  places 
would  most  naturally  divide  into  three  distinct  grades.  The 
first  class  of  hospitals  should  be  for  recent  cases,  where  the 
inmates  can  be  committed  by  the  courts,  or  voluntarily  com- 
mit themselves  for  one  or  two  years.  The  second  class 
should  receive  chronic  cases  for  longer  terms  of  treatment 
— from  one  to  three  years.  The  third  class  should  be  for 
the  incurables,  or  those  who  give  no  reasonable  promise  of 
restoration.  The  time  should  be  from  five  to  ten  years  and 
life. 

The  latter  class  should  be  thoroughly  organized  into 
military  habits  of  life  and  work,  and  kept  in  the  best  con- 
ditions of  forced  healthy  living.  Employment  and  mental 
occupation  should  be  carried  out  literally  as  a  stimulus  to 
strengthen  the  body  and  mind.  Where  it  was  possible  the 
rewards  of  his  labor,  beyond  a  sum  to  pay  for  care,  should 


GENERAL   CONSIDEEATIONS    OE   TREATMENT.  201 

be  turned  over  to  his  family  and  friends  or  held  in  trust 
for  him.  He  should  be  encouraged  to  healthy  work  and 
living  by  all  possible  means  and  surroundings.  The  semi- 
chronic  cases  should  be  treated  substantially  the  same  way, 
only  occupation  and  training  of  the  mind  and  body  should 
be  more  suited  to  the  wants  of  each  case.  The  amusements 
should  also  be  of  a  sanitary  character. 

The  recent  cases  should  have  the  same  exact  discipline, 
filling  the  mind  with  new  duties  and  new  thoughts,  and 
suited  to  build  up  the  exhausted,  overworked  man,  as 
well  as  the  gormand  and  under-worked  idler.  All  persons 
should  pay  for  their  care  if  possible,  and  be  required  to 
render  some  service  which  would  be  credited  on  their  bills. 
These  hospitals  should  be  literally  quarantine  stations, 
where  the  inebriate  can  be  housed  and  protected  and 
society  saved  from  the  losses  following  his  career. 

If  ten  thousand  poor  chronic  inebriates  could  be  taken 
from  New  York  and  placed  in  such  hospitals,  and  made  self- 
supporting,  who  could  estimate  the  gain  to  society,  to 
morals,  to  the  tax-payer,  and  to  civilization  ?  This  can  and 
will  be  done  in  the  near  future.  If  ten  thousand  semi-chronic 
cases  of  inebriety  could  be  taken  from  New  York  and 
quarantined  two  or  five  years  in  such  military  hospitals, 
and  made  to  pay  for  their  care  by  labor,  who  could  estimate 
how  many  would  be  returned  to  health  and  temperate  liv- 
ing again  ? — who  could  estimate  the  relief  from  sorrow, 
misery,  wretchedness,  and  losses  ?  This  will  also  be  a 
reality  a  little  fartlier  on.  If  ten  thousand  recent  cases  of 
inebriety  could  be  taken  out  of  their  surroundings  in  New 
York  and  placed  in  these  hospitals,  where  forced  conditions 
of  the  highest  degree  of  health  and  vigor  are  maintained, 
a  large  percentage  would  recover.  The  gain  to  society  and 
the  world  would  be  beyond  all  computation.  Now  each 
one  of  these  propositions  and  the  practical  working  of  a 
military  hospital  is  a  reality,  based  on  evidence  constantly 
accumulating.    Every  prison,  penitentiary,  or  hospital,  every 


202  DISEASES    OF   INEBEIETT. 

asylum  or  home  where  inebriates  come  under  care  and 
restraint  bring  such  evidence.  They  show  that  such  a 
method  of  treatment,  combining  the  varied  experiences  of 
all  these  institutions  can  be  made  practical  and  is  the  only 
scientific  way  of  solving  this  problem. 

To  banish  the  still  and  saloon  does  not  prevent  inebriety 
or  cure  the  inebriate  ;  it  only  changes  the  direction  of  the 
drink  current.  But  quarantine  the  inebriate  in  a  hospital, 
as  one  suffering  from  contagious  disease,  and  the  victim  is 
cured,  the  spread  of  the  disease  is  prevented,  and  a  knowl- 
edge of  the  causes  ascertained,  from  wiiich  the  remedies 
can  be  known  and  applied.  To  punish  the  inebriate  as  a 
criminal  cannot  cure  his  inebriety,  but  it  always  unfits  him 
for  living  a  temperate,  healthy  life  hereafter.  To  attempt 
a  cure  by  faith  and  prayer  is  to  depend  on  false  hopes,  the 
failure  of  which  is  followed  by  increased  degeneration. 
To  attempt  any  form  of  treatment  without  knowing  any 
other  fact  except  that  the  victim  drinks  to  excess  is  always 
to  blunder  and  fail. 

The  time  has  come  to  recognize  the  physical  conditions 
which  enter  into  all  cases  of  inebriety,  and  to  apply  exact 
remedies  along  the  line  of  nature's  laws  and  forces. 

The  late  Dr.  Bellows,  in  an  address  delivered  in  1858, 
said  :  "  Inebriates,  like  criminals  and  insane,  will  all  be 
eventually  restrained  in  hospitals,  and  treated  with  medical 
and  psychological  skill  the  moment  their  liberty  becomes 
dangerous  to  society.  The  terms  of  their  confinement  will 
be  limited  only  by  the  possibilities  of  cure  and  tiie  con- 
ditions of  their  disorder.  Society  gains  nothing  by  holding 
prisoner  for  an  hour  any  man  who  is  fit  to  be  at  large. 
Liberty  and  human  rights  gain  nothing  by  allowing  anv 
man  to  be  at  large  for  a  moment  who  is  destroying  himself, 
his  family  and  his  neighbors.  What  we  need  is  what  we 
are  fast  gaining,  namely,  a  possession  of  the  tests  and 
gauges  of  the  fitness  and  unfitness,  and  we  shall  be  able  to 


GENERAL   CONSIDERATIONS    OF   TREATMENT.  203 

treat  the  inebriate  successfully  the    same   as  in  other  dis- 
eases." 

Sorne  general  idea  of  the  details  of  treatment  will  be  of 
interest.  In  a  hospital  conducted  on  scientific  common- 
sense  principles  the  patients  are  received  for  periods  of  not 
less  than  three  or  six  months.  The  patient  signs  a  commit- 
ment paper,  and  is  examined  by  the  physician,  and  all  the 
facts  of  his  present  and  past  condition  noted.  If  intoxi- 
cated he  is  placed  in  charge  of  a  nurse  and  baths  and 
remedies  given  for  his  special  condition.  If  sober  he  is 
given  a  pleasant  room  and  placed  upon  a  regular  diet,  exact 
conditions  of  living,  and  required  to  take  such  medicines, 
baths,  exercise,  and  general  treatment  as  may  be  needed  in 
his  case.  Mental  occupation,  amusement,  change  of  thought 
and  life  in  every  particular  are  sought  for.  He  is  treated 
as  one  u'ho  has  a  profound  disease  of  the  brain  and  nervous 
system,  requiring  rest,  care,  and  removal  from  every  source 
of  irritation  and  excitement.  The  question  of  responsibility 
to  aid  the  efforts  of  the  hospital  in  his  behalf  is  urged  as  a 
S5'mptom  of  his  capacity  or  incapacity  to  recover.  The 
asylum  is  a  quarantine  where  he  can  recover,  and  his 
liberty  or  restraint  is  governed  by  his  condition.  Wherever 
congenial  work  can  be  added  to  the  amusement  it  is  done 
as  a  medical  aid.  Every  condition  of  life  is  controlled  and 
regulated,  and  every  surrounding  arranged  to  aid  recovery. 
Daily  religious  exercises,  rides,  walks,  Turkish  baths,  and 
exact  methodical  living,  most  naturally  result  in  a  degree 
of  strength  and  vigor  that  is  very  promising  for  the  future. 
To  accomplish  this  the  asylum  must  be  pleasantly  located, 
the  building  must  be  cheerful  and  sunny,  and  adapted  to 
the  work.  The  surroundings  must  be  free  from  all  sources 
of  irritation  and  unpleasantness,  such  as  noise,  excitement  ; 
and  the  management  must  seek  to  apply  remedies  to  meet 
the  wants  of  every  case.  Thus,  in  some  instances,  sharp 
restraint  is  a  tonic  remedy  of  value  ;  in  others  it  is  depress- 
ing.    In  some  cases  nerve  rest  and  regularity  of  living  is  of 


204  DISEASES    OF    INEBRIETY. 

more  value  than  all  other  things.  The  physician  finds 
from  a  study  of  each  case  a  most  bewildering  complexity 
of  causes,  beginning  with  heredity  and  including  every- 
thing which  produces  distinct  strain  or  drain  on  the  nerves 
and  brain. 

The  great  object  of  all  inebriate  asylums  is  to  practi- 
cally quarantine  the  inebriate,  where  all  the  exciting  causes 
are  removed,  and  every  predisposing  cause  is  antagonized, 
and  where  the  most  favorable  conditions  for  rest  and  build- 
ing up  can  be  secured.  The  remedies  to  aid  in  this 
work  are  indicated  by  the  special  condition  present,  and 
include  all  the  nerve  and  brain  tonics,  the  common  property 
of  the  profession.  The  physical  remedies,  are  diet,  baths, 
exercise  ;  and  the  mental  remedies,  including  mental  occu- 
pation, amusement,  change  of  thougiit  and  mind,  growth 
out  of  the  past,  are  all  essential  and  equally  valuable. 
Restraint  and  freedom,  rewards  and  punishment,  appealing 
to  the  will  and  ignoring  it,  etc.  Rules  and  regulations  for 
every  act  of  life  ;  few  rules,  which  the  patient  applies  him- 
self, and  so  on,  using  the  most  diverse  means  which  would 
apply  to  the  special  need  of  each  case. 

The  condition  or  disease  to  be  treated  is  a  profound 
physical  disordei",  and  the  toxic  use  of  alcohol  is  always  a 
symptom  as  well  as  a  cause.  The  best  efforts  of  science  is 
to  break  up  this  cause,  and  change  the  symptoms.  The 
defects  continue,  the  man  is  permanently  impaired.  He  may 
go  back  to  active  life  and  do  well,  but  ever  after,  as  a  rule, 
the  same  range  of  causes  will  produce  the  results. 

In  a  certain  number  of  cases  the  drink  impulse  or 
symptom  seems  to  be  permanently  exiiausted  after  a  time 
like  the  exhaustion  of  the  germ  soil  of  some  diseases, 
and  no  exciting  causes  will  develop  the  drink  symptoms 
again.  Other  defects  may  appear,  but  he  never  again  uses 
spirits.  The  germ  soil  has  gone,  it  may  be  forever,  or  after 
lapse  of  years  it  will  return. 

A  period  of  six   or  twelve   months  in  an  asylum  will  re- 


GENERAL   CONSIDERATIONS   OF   TREATMENT.  205 

move  the  states  of  delirium  which  have  kept  up  the  use  of 
alcohol,  and  reveal  an  exhausted  brain  and  nerve  soil  that 
will  not  tolerate  alcohol  in  any  form  after.  The  person  sud- 
denly realizes  that  alcohol  is  both  poisonous  and  repelling 
to  his  system.  This  may  be  so  intense  that  should  he  take 
any  form  of  spirits  by  mistake  it  will  produce  intense  nau- 
sea and  depression.  In  other  cases  the  drink  exhaustion 
dies  out  after  long  years  of  abstinence,  and  should  the  pa- 
tient relapse  late  in  life,  death  follows  soon  after.  A  care- 
ful study  in  an  asylum  often  reveals  these  cases,  and  the 
expert  can  safely  predict  a  total  or  partial  cure  of  the  drink 
symptoms  and  disorder,  or  its  temporary  suppression,  only 
to  break  out  again.  Another  fact,  not  generally  known, 
appears  to  the  asylum  physician,  namely  the  great  uniform- 
ity of  the  symptomology  and  progress  of  these  cases.  Be- 
ginning at  a  certain  point,  or  from  certain  range  of  causes, 
they  follow  a  uniform  line  of  progress,  which  can  often  be 
seen,  traced,  and  predicted  with  certainty. 

In  an  asylum  the  stage  of  progress  can  frequently  be 
seen,  and  means  for  its  prevention  or  diversion  can  be 
applied.  In  an  asylum  all  tlie  conditions  of  life  can  be  reg- 
ulated ;  the  food,  the  surroundings,  the  pei'iod  of  rest  and 
activity  ;  the  mental  states  can  be  antagonized  or  prevent- 
ed ;  the  local  condition  from  which  irritation  is  produced 
can  be  removed  ;  the  physical  irritation  which  keeps  up  the 
drink  impulse  is  changed.  The  asylum  treatment,  like  the 
quarantine  for  contagious  disease,  isolates  the  victims  from 
all  exciting  and  predisposing  causes,  and  thus  places  him  in 
the  best  possible  condition  for  returning  health.  Asylum 
and  medical  treatment  for  the  inebriate  are  most  impera- 
tively demanded,  not  only  to  save  the  victim,  but  to  enable 
us  to  understand  some  of  the  great  underlying  causes  which 
are  active  in  precipitating  so  many  men  into  this  terrible 
disease. 

Primarily  in    the   treatment  we  have  shattered  constitu- 
tions, and  broken-down  nervous  systems  to  deal  with.     We 


206  DISEASES    OF   INEBEIETY. 

have  a  disease  eminently  marlced  by  weal^ening  of  the  will- 
power, and  seclusion  from  society,  rest,  judicious  restraint, 
and  enforced  abstinence  from  ail  alcohol  stimuli  are  car- 
dinal points  of  treatment.  I  always  let  patients,  applying 
to  me  for  treatment,  distinctly  understand  that  a  permanent 
recovery  depends  largely  on  allowing  sufficient  time  for 
restoration  of  nerve-power,  mental  tone,  and  physical  vigor, 
and  I  think,  in  most  cases,  six  months  is  the  least  time  nec- 
essary for  a  complete  recuperation  of  the  will-power.  Dip- 
somania is  a  disease  that  requires  the  most  perfect  disci- 
pline, both  moral  and  physical,  if  we  expect  a  cure.  Peri- 
odical insanities  are  notably  difficult  to  cure  so  that  there 
is  no  chance  of  a  relapse,  but  we  may  reasonably  expect  an 
ultimate  cure  if  there  is  but  little  structural  change  in  the 
brain  which  has  resulted  from  the  course  of  inebriety. 

The  heart's  action  in  dipsomaniacs  is  weak,  often  irreg- 
ular, accompanied  by  palpitation.  There  is  a  loss  of  tone 
in  character,  blunting  of  moral  perceptions,  impairment  of 
intellectual  discrimination,  and  generally  impairment  of  all 
the  mental  faculties.  There  is  very  often  an  utter  inability 
to  fix  the  mind  on  any  one  subject,  or  to  follow  up  a  train 
of  thought  consecutively.  We  see  periods  of  abnormal 
cerebration  ;  an  instantaneous  abeyance  of  reason  and 
judgment  ;  a  condition  resembling  an  epileptic  state,  dur- 
ing which  period  the  inebriate  may  be  actuated  by  mad, 
ungovernable,  or  eccentric  impulses  ;  a  condition  in  which 
disease  has  deprived  him  of  the  power  of  choice,  and  during 
which  states,  in  my  opinion,  the  inebriate  is  as  little  respon- 
sible for  his  actions  as  is  a  person  suffering  from  any  other 
phase  of  mental  disease.  I  knew  a  gentleman  of  high 
social  standing  in  this  city  who  has  these  mental  blanks, 
during  which  time  he  rides  up  and  down  New  York  in  a 
horse-car,  aimlessly,  and  has  no  recollection  afterward  of 
having  done  this  at  all. 

These  are  very    interesting    cases    from    a    medico-legal 
point  of  view.     In  these  cases  the  healthy  coordination  of 


GENERAL    CONSIDERATIONS    OF    TREATMENT.  207 

ideas  is  destroyed  for  the  time,  and  tlie  patient  need  not  be 
alcoholized  to  liave  such  states  occur.  In  cases  of  inebriety 
or  dipsomania  we  liave  to  deal  with  the  results  of  a  toxic 
poison,  and  we  may  have  various  complications  proceeding 
from  the  abuse  of  alcoliol,  such  as  cirrhosis  of  the  liver, 
gastritis,  epilepsy,  various  forms  of  dyspepsia,  and  in  some 
cases  with  Bright's  disease.  We  may  also  find  a  simple 
hypertrophy  of  the  left  ventricle  of  the  heart,  and  degen- 
erated arteries.  Our  patient  must  have  cheerful,  tranquil, 
and  pleasant  surroundings  ;  all  cerebral  excitement  must  be 
repressed  ;  sleep  must  be  procured  ;  plenty  of  nourishing, 
easily  digested  food  administered  at  sliort  intervals,  and  an 
abundance  of  fresh  air  and  exercise.  I  am  not  in  favor  of 
much  meat  in  tlie  diet  list.  Certainly  none  at  all,  except  at 
dinner,  and  I  think  a  strict  diet  list,  so  that  the  work  of  the 
liver  and  kidneys  is  diminished  by  lessening  the  amount  of 
highly  nitrogenized  food  and  of  the  hydro-carbons,  gives 
decidedly  the  best  result.  Fish,  oysters,  and  fruits  that  con- 
tain sugar,  the  green  vegetables,  bread,  wheaten  meal,  and 
oatmeal  are  all  permissible.  Potatoes  should  be  eaten 
somewhat  sparingly,  and  eggs  also.  Poultry  and  the  white 
meats  are  well  borne.  Beef  and  mutton  are  not  so  well 
borne,  and  are  contra-indicated,  except  at  dinner. 

Exercise  in  the  open  air  is  indispensable.  The  action  of 
the  skin  must  be  stimulated,  and  systematic  skin  friction 
w^ith  cold  sponge  or  shower  baths  do  much  good.  Also 
the  Turkish  bath  is  useful.  The  natural  saline  mineral 
waters  are  the  best  to  stimulate  excretory  action  by  the 
abdominal  organs.  The  Hunyadi-Janos,  Friedrichshall 
vi^ater,  and  Saratoga  Congress  water  are  the  best,  while  foi' 
diuretic  waters,  Saratoga  Vichy  and  Apollinaris  water  arc 
the  best. 

We  have  a  worn,  irritable  condition  of  the  nervous 
system  in  inebriates,  an  unstable  condition  as  regards  its 
nutrition,  its  solidity,  and  its  perfection  of  structure.  We 
must  supply  the  greatest  amount  of  nutritive  material  to  the 


208  DISEASES    OF   INEBRIETY. 

brain  and  nervous  system  to  repair  the  existing  nutritive 
lesion.  We  must  supply  the  phosphates  in  some  way,  the 
many  eligible  preparations  containing  them  being  familiar 
to  you  all.  All  abnormal  nervous  excitability  must  be 
quieted,  and  our  patient  kept  calm  and  tranquil.  A  pro- 
longed warm  bath  at  night,  followed  by  the  administration 
of  one  teaspoonful  of  the  ammoniated  tincture  of  lupuline, 
or  of  a  pill  of  camphor,  ext.  hyoscyamus,  and  pulv.  digitalis 
will  often  quiet  the  nervous  excitability. 

Care  must  be  given  to  the  excretory  functions  of  the 
skin,  kidneys,  and  bowels.  If  there  is  headache  and  drow- 
siness, such  diuretics  as  the  liq.  ammoniac  acetat.,  w'ith  spt. 
nitric  ether  are  indicated.  Indian  hemp  has  proved  itself 
in  my  hands  a  valuable  adjunct,  in  doses  of  X  gr.  of  the 
extract,  as  required.  A  very  valuable  sedative  mixture  is 
one  composed  of  30  grains  of  bromide  of  sodium  and  30 
minims  of  tinct.  of  cannabis  indica  prepared  with  water,  at 
the  time  required.  It  induces  calmness  and  tranquility,  and 
can  be  repeated  thrice  daily,  if  required,  without  the  loss 
either  of  flesh  or  appetite.  One  of  our  most  valuable  remedial 
agents  in  inebriety  is  phosphorous,  which  I  always  give  in 
i-ioo  to  1-25  gr.  doses  in  cod  liver  oil  after  meals.  Cod 
liver  oil  is  one  of  the  best  nutritive  remedies,  as  fat  must 
be  applied  to  the  nutrition  of  the  nervous  system  if  this  is 
to  be  maintained  in  its  organic  integrity.  The  general 
effects  of  phosphorous  are  those  of  a  stimulant,  but  it  pos- 
sesses a  special  power  over  the  exhausted  nervous  system. 
It  is  perhaps  evanescent  in  its  effects,  but  is  never  followed 
by  a  stage  of  depression  wdiich  is  noticable.  It  should 
never  be  ordered  upon  an  empty  stomach.  A  pill  of  iron, 
phosphorous,  zinc,  and  strychnia  is  also  very  useful,  and 
combinations  are  often  more  beneficial  than  the  medicines 
when  taken  singly, 

A  large  percentage  of  all  cases  of  inebriety,  before 
admission  into  our  institutions  for  the  cure  of  inebriety, 
have  passed  through  the  primary  and  acute  stages,  and  liav^ 


GENERAL    CONSIDERATIONS    OF    TREATMENT.  209 

probably  been  subjected  to  medical  treatment.  This  fact 
must  never  be  lost  sight  of  in  forming  our  opinion,  not  only 
of  the  nature  of  the  disease  itself,  but  of  the  medical  treat- 
ment necessary  for  its  cure.  We  often  discover  that  the 
dipsomania  has  been  allowed  to  exist  and  slowly  progress 
for  a  considerable  period,  no  treatment,  either  medical  or 
moral,  having  been  adopted  for  its  removal. 

The  most  simple  classification  of  inebriety,  the  one  best 
adapted  for  useful  and  practical  purposes,  is  its  division  into 
the  acute, periodic,  and  chronic  forms.  The  acute  form  is  the 
rarest,  and  is  ushered  in  by  exhausting  diseases,  or  excessive 
sexual  excess.  The  periodic  form  is  much  more  frequent, 
and  it  is  to  this  form  of  inebriety  that  I  would  recommend 
the  term  dipsomania  to  be  restricted.  It  is  frequently 
hereditary,  like  all  insanities,  and  strictly  periodic  in  its 
paroxysms.  These  patients — dipsomaniacs — may  abstain 
for  weeks  or  months,  and  may  during  this  interval  positively 
dislike  stimulants. 

The  last  or  chronic  form  of  inebriety  is  very  incurable, 
as  the  patients  are  incessantly  under  the  desire  for  alcoholic 
stimulants,  and  will  get  them  if  any  opportunity  occurs, 
whereas  the  dipsomaniac  have  only  the  irresistible  craving 
for  stimulants  periodically.  It  is  in  these  cases  of  chronic 
inebriety  that  we  find  hallucinations  of  sight  and  hearing, 
very  painful  moral  impressions,  confusion  of  thought, 
suicidal  tendencies,  tremors  of  the  facial  muscles  and 
tongue,  and  very  often  paralytic  symptoms,  ending  in  gen- 
eral paralysis.  It  is  here,  in  chronic  inebriety,  that  disease 
of  tlie  brain  may  destroy  all  apparent  consciousness  of  pain, 
and  keep  in  abeyance  the  outward  and  appreciable  mani- 
festations of  the  important  indications  of  organic  mischief. 
Extensive  disease  of  the  stomach,  lungs,  kidneys,  bowels, 
uterus  and  heart  have  been  known  to  have  progressed  to  a 
fearful  extent  without  any  obvious  recognizable  indication 
of  the  existence  of  such  affections. 

The    most    essential     preliminary    matters    for    inquiry 


210  DISEASES    OF    INEBRIETY. 

relating  to  the  treatment  of  inebriety,  have  relation  to  the 
age,  temperament,  previous  occupation  and  condition  in 
life  of  the  patient.  It  will  be  necessary  to  ascertain  the 
character  and  duration  of  the  attack,  to  ascertain  whether 
it  has  resulted  from  moral  or  physical  causes  ;  if  of  sudden, 
insidious,  or  slow  growth  ;  whether  it  has  an  hereditary 
action,  or  is  the  effect  of  a  mental  shock  or  of  mechanical 
injury  ;  whether  it  is  the  first  attack,  and  if  not,  in  what 
features  it  differs  from  previous  paroxysms.  It  will  also  be 
our  duty  to  inquire  whether  it  is  complicated  with  epilepsy, 
insanity,  suicidal  or  homicidal  impulses.  If  any  prior  treat- 
ment has  been  adopted  we  must  learn  its  nature  ;  whether 
the  patient  has  suffered  from  gout,  heart  disease,  rheuma- 
tism, skin  disease,  or  syphilis.  It  is  important  in  cases  of 
females  to  obtain  accurate  information  in  relation  to  the 
condition  of  the  uterine  functions.  We  should  also  inquire 
whether  the  patient  has  been  suspected  of  habits  of  self- 
abuse. 

Having  obtained  accurate  information  upon  these  essen- 
tial points,  our  own  personal  observation  will  aid  us  in 
ascertaining  the  character  of  the  inebriety.  The  configura- 
tion of  the  head,  chest,  and  abdomen  ;  the  gait  of  the  pa- 
tient ;  the  degree  of  sensibility  and  volitional  power  mani- 
fest ;  the  state  of  the  retina,  the  pulse,  the  temperature  of 
the  head  and  body  ;  the  condition  of  the  skin  and  chylopoie- 
tic  viscera  ;  the  action  of  the  heart,  lungs,  and  nature  of  any 
existing  disease  of  the  uterus  should  be  noticed.  Onv prog- 
nosis in  cases  of  inebriety  will  mainly  depend  upon  the  dura- 
tion of  the  attack,  its  character  and  origin,  and  the  diathe- 
sis of  the  patient.  The  prognosis  is  unfavorable  if  the 
disease  is  hereditary.  Age  materially  guides  us  in  forming 
a  correct  prognosis.  The  greater  proportion  recover  be- 
tween the  ages  of  twenty  and  thirty-five.  When  a  patient 
has  youth  and  a  good  constitution,  and  remedial  measures 
are    promptly  applied  to  the  patient  while  he  is  secluded 


GENERAL    CONSIDERATIONS    OF   TREATMENT.  211 

from  all  occasion  of  temptation,  the  prognosis  is  favorable. 
I  have  seen  patients  after  forty  and  fifty  recover. 

The  prognosis  is  unfavorable  when  inebriety  is  associ- 
ated with  organic  disease  of  the  heart  or  lungs,  or  when 
great  impairment  of  mind,  associated  with  paralysis,  is  pres- 
ent. Prolonged  hot  baths  are  of  the  utmost  service  in  the 
treatment  of  inebriety.  Among  the  therepeutic  effects  of 
these  baths  I  would  mention  a  diminution  of  the  circulation 
and  respiration,  relaxation  of  the  skin,  alleviation  of  thirst, 
the  introduction  of  a  good  deal  of  water  into  the  system,  an 
abundant  discharge  of  limpid  urine,  a  tendency  to  sleep, 
and  a  state  of  repose.  It  is  most  useful  in  acute  and  chronic 
inebriety.  The  preparations  of  hyoscyamus,  conium,  stra- 
monium, camphor,  hops,  aconite,  ether,  chloroform,  and 
Indian  hemp  are  all  of  great  service  if  given  with  judgment. 
The  best  plan  in  practice  would  seem  to  be  to  judiciously 
combine  various  kinds  of  sedatives.  Milk  heated  almost  to 
boiling  is  very  valuable.  It  allays  irritability  of  the  stomach 
and  craving  for  stimuli,  and  two  glasses  at  night  have  a 
very  sedative  effect. 

If  there  are  decided  signs  of  cerebral  congestion  the 
occasional  application  of  a  leech  behind  the  ear  is  good 
practice.  If  symptoms  of  softening  of  the  brain  appear 
they  will  often  yield  to  the  persevering  use  of  the  prepara- 
tions of  iron,  phosphorous,  zinc,  and  strychnia,  with  gener- 
ous living.  Strychnia  antidotes,  it  appears  to  me,  slight 
impairment  of  the  mind,  loss  of  memory,  defective  power  of 
attention  in  inebriety  very  perfectly,  and  may  be  combined 
with  two  gr.  doses  of  quinia  thrice  daily.  If  inebriety  is 
associated  with  suicidal  tendencies  it  will  be  important  to 
ascertain  whether  any  cerebral  congestion  exists,  and  if  so, 
a  few  leeches  applied  to  the  head,  followed  by  an  active 
cathartic,  will  relieve  the  local  irritation.  In  the  absence 
of  any  positive  active  cerebral  symptoms,  the  prolonged 
warm  bath  and  the  continued  exhibition  of  morphia  will  be 
the  best  treatment  until  the  suicidal  idea  disappears. 


212  DISEASES    OF   INEBRIETY. 

We  need  both  State  and  national  hospitals  for  the 
cure  of  inebriety,  places  of  detention  or  asylums,  under  the 
care  of  medical  officers  well  trained  by  preliminary  educa- 
tion for  their  vocation,  and  acquainted  thoroughly  with 
inebriety. 

One  of  the  best  remedial  agents  whicli  can  be  employed 
in  inebriety  is  electricity.  Both  the  constant  and  induced 
currents,  or  galvanic  and  Faradic  electricity,  may  be  used. 
Electricity  is  a  true  nerve  tonic,  and  it  is  an  agent  which 
furnishes  us  with  the  means  of  modifying  the  nutritive  con- 
dition of  parts  deeply  situated,  and  of  modifying  the  circula- 
tion to  a  greater  extent,  I  think,  than  by  any  known  agent. 
By  the  judicious  employment  of  the  constant  and  induced 
currents  we  have  it  in  our  power  to  hasten  the  processes  of 
nerve  growth  and  nerve  repair,  and  thereby  hasten  the 
acquisition  of  nerve  power. 

The  use  of  electrictity  does  not,  I  think,  act  by  contribut- 
ing anything  directly  to  the  growth  or  repair  of  nerve 
tissue.  Its  action  is  to  stimulate  and  quicken  those  pro- 
cesses on  which  the  material  and  functional  integrity  of  the 
nervous  system  depends.  The  use  of  electricity  in  inebriates 
is  always  followed  by  an  increase  of  strength  and  nerve 
force,  and  the  results  gained  are  gradual  and  permanent. 
Dipsomania  or  periodical  inebriety  is  characterized  by 
abnormal  nervous  excitability,  conjoined  with  cerebral 
exhaustion,  and  the  two  indications  which  are  urgent 
are,  primarily,  for  increased  rapidity  and  effective- 
ness as  regards  the  process  of  nerve  nutrition,  and  second- 
arily, to  secure  freedom  from  excitement,  and  diminution  of 
nerve  activity,  and  thereby  to  check  the  waste  of  nerve 
structure  and  of  power.  These  indications  we  can  fulfill  by 
the  judicious  use  of  electricity  and  nerve  tonics  more  cer- 
tainly than  by  any  other  means,  there  being  no  other  such 
combined  sedative,  restorative,  and  refreshant  to  the  central 
nervous  system.     To  give  the  brain   the  direct  nutriment  it 


GENERAL    CONSIDERATIONS    OF    TREATMENT.  213 

needs  in  inebriety,  I  Iiave  before  stated,  can  be  accomplished 
by  rest,  cod  liver  oil,  phosphorus,  the  phospliates,  etc. 

Every  intelligent  person  who  has  observed  the  march  of 
human  thought  into  the  recently  explored  realms  of  Psycho- 
logical medicine  and  the  treatment  of  mental  diseases, 
will  get  new  views  as  to  modes  of  treatment,  more  especi- 
ally of  that  class  for  whom  institutions  were  organized. 
The  favorable  results  of  each  succeeding  year,  only  confirm 
and  demonstrate  the  truth  of  the  humane  and  wise  idea 
that  led  to  the  organization  of  institutions,  viz.  :  that 
intemperance  in  all  its  stages  may  be  not  only  checked  and 
mitigated,  but  in  many  instances  permanently  cured,  and 
the  subject  fully  restored  to  his  normal  condition  of  health 
and  sobriety. 

Such  results  may  not  be  reached  by  the  final  and  utter 
extinction  of  the  morbid  desire  for  alcohol,  so  much  as  by 
a  development  and  cultivation  of  opposite  and  ennobling 
qualities,  which  by  their  vital  action,  hold  the  depraved 
mental  tendencies  of  the  subject  in  constant  and  absolute 
subjection,  so  that  they  become  as  inoperative  as  if  they 
did  not  exist. 

This  is  as  near  an  absolute  cure  as  we  can  hope  to 
reacli,  as  the  testimony  of  all  inebriates  concurs  in  the  fact 
that  the  appetite  for  intoxicating  drink  never  dies,  though 
it  may  be  put  to  a  life-long  sleep. 

It  cannot  be  expected  that  the  final  and  complete  results 
of  the  treatment  of  our  patients,  so  variously  circumstanced 
and  conditioned,  can  be  fully  known.  From  this  common 
center  of  reform,  hundreds  have  struck  out  in  new  and 
divergent  paths,  and  are  lost  to  our  view  in  the  general 
whirl  of  business  and  laudable  enterprise.  Whenever  any 
one  does  fall  into  his  previous  habits,  we  are  certain  to  be 
informed  of  the  fact,  as  few  things  travel  so  fast  and  so 
sure  as  ill-tidings  of  man's  vices  and  misfortunes. 

We  can  congratulate  ourselves  on  the  fact  that  thousands 
who  have  been  under  hospital   care  are   now   in   active   life 


214-  DISEASES    OF   INEBRIETY. 

all  over  the  country,  of  wliose  doings  we  are  cognizant,  and 
it  is  a  source  of  pleasure  to  us  to  know  that  their  correct 
and  consistent  conduct  is  productive  of  liappiness  to  them- 
selves, and  does  iionor  to  the  institutions  and  the  humane 
work  which  it  has  in  hand. 


CHAPTER  XXII. 

ASYLUMS     AND    THEIR    WORK    IN    THE    TREATMENT   OF 
INEBRIETY. 

Asylums  and  hospitals  for  the  treatment  and  cure  of 
inebriates  are  only  modern  applications  of  truths  asserted 
centuries  ago.  Ulpian,  tlie  Roman  jurist,  in  the  second  cen- 
tury of  the  Cliristian  era,  urged  the  necessity  of  treating 
inebriates  as  sick  and  diseased,  in  special  surroundings,  with 
special  means.  Other  authorities  indorsed  these  views,  and 
asserted  that  the  State  sliould  recognize  the  veritable  mad- 
ness of  drunkards  and  treat  tliem  as  such. 

In  1747  Condillac,  of  France,  wrote  that  the  State  should 
provide  special  hospitals  for  drink  maniacs,  and  urged  a 
change  of  law  and  public  sentiment  to  this  end.  Dr.  Rush 
of  Philadelphia,  in  1790  ;  Dr.  Cabanis  of  Paris,  in  1802  ; 
Prof.  Platner  of  Leipsic,  in  1809  ;  Salvator  of  Moscow,  in 
1817  ;  Esquirol  of  France,  in  1818  ;  Buhl  Cramner  of  Berlin, 
in  1822,  all  urged  the  need  of  physical  restraint  and  treat- 
ment of  the  inebriate  as  sick  and  diseased,  in  places  espec- 
ially provided  for  this  class.  In  1830  the  Connecticut 
Medical  Society  appointed  a  committee  to  report  on  the 
need  of  an  asylum  for  the  medical  treatment  of  inebriates. 
In  1833  Dr.  Woodward,  of  tlie  Worcester  Insane  Asylum, 
in  Massachusetts,  urged  that  inebriety  be  recognized  as  a 
disease,  and  special  hospitals  be  provided  for  its  treatment. 
In  1844  the  English  Lunacy  Commission  urged  that  inebri- 
ates be  regarded  as  insane,  and  sent  to  asylums  for  special 
treatment.  These  are  only  a  few  of  the  more  prominent 
references    to     inebriate   asylums,    although     many    other 

215 


216  DISEASES    OF   INEBRIETY. 

writers  urged  the  same  views  in  different  ways.  The  men- 
tion of  tlie  disease  of  inebriety  roused  a  bitter  opposition, 
and  the  question  of  asylums  was  put  aside  until  the  former 
could  be  settled. 

In  1846  Dr.  Turner  began  an  entliusiastic  agitation, 
which  culminated  in  the  first  asylum  at  Binghamton,  New 
York. 

The  opposition  to  this  work  was  very  intense,  and  came 
from  moralists,  who  urged  that  it  was  a  purely  "  infidel 
work  "  to  diminish  human  responsibility.  Tlie  asylum  at 
Binghamton  began  on  the  most  advanced  principles,  of 
receiving  no  one  for  less  than  one  year,  and  having  abso- 
lute restraint  over  them  during  this  time.  It  asked  no 
pledges  or  promises  from  the  patient  ;  it  aimed  to  give 
each  one  positive  protection  and  medical  treatment.  The 
patients  were  locked  in  at  night,  and  only  allowed  out 
under  the  strict  care  of  attendants.  Each  case  was  consid- 
ered a  suicidal  case  of  insanity,  requiring  long  medical  care 
and  restraint. 

These  methods  were  far  in  advance  of  that  time,  and  even 
to-day  are  just  beginning  to  be  recognized  as  the  latest 
teacliings  of  science.  The  patients  themselves,  after  the 
immediate  recovery  from  the  effects  of  spirits,  protested 
against  the  confinement  and  doctrine  of  disease,  and  sought 
in  every  way  through  their  friends  to  break  up  the  methods 
of  treatment.  The  points  of  difference  were  these  :  The 
asylum  and  management  insisted  that  each  case  was  more 
or  less  diseased,  and  should  be  under  absolute  control  and 
restraint  for  long  enough  time  to  effect  a  permaraent  cure. 
The  patients  and  their  friends  insisted  that,  while  the  case 
might  be  diseased,  his  recovery  depended  largely  upon  his 
liberty  and  promise  to  get  well  ;  that  restraint  was  irrita- 
tion and  injury;  and  that  appeals  to  his  honor  and  man- 
hood were  the  real  agents  for  final  cure.  In  brief,  one  plan 
proposed  long  restrain  ;  the  other,  no  restraint  except  nom- 
inal care  at  first,  then  persuasion  and  advice. 


ASYLUMS    AND    THEIR    WORK.  217' 

The  board  of  management  changed,  and  the  central 
object  was  to  make  the  asylum  popular  with  the  patient. 
Political  controversy  followed,  and  the  State  changed  the 
asylum  to  an  insane  hospital,  and  a  political  governor,  in 
justification  of  the  act,  called  the  inebriate  asylum  a  failure. 
,  The  asylums  in  this  country  for  the  treatment  of  inebri- 
ates may  be  divided  into  three  classes. 

ist.  Those  hospitals  which  have  been  established  by  cor- 
porations receiving  State  aid,  or  by  private  enterprise,  and 
incorporated,  having  the  advantage  of  the  laws,  where  the 
inebriate  is  regarded  as  diseased,  and  treated  on  broad  sci- 
entific principles. 

2d.  Hospitals,  both  corporate  and  private,  wnere  the 
inebriate  is  admitted  with  other  cases  of  mental  disease  ; 
mild  maniacs,  and  eccentrics  of  all  degrees  of  debility,  of 
both  mind  and  body.  Here  the  inebriate  is  treated  from 
some  mixed  theory  or  half  disease  and  half  vice  ;  when  he 
has  recovered  from  the  acute  symptoms,  is  held  as  fully  sane 
and  responsible. 

The  third  class  of  hospitals  ignore  all  question  of  disease 
except  that  which  comes  from  the  direct  use  of  alcohol, 
which  from  their  theory  can  be  quickly  remedied.  The 
treatment  of  the  case  is  by  the  pledge,  prayer  and  promise. 

The  first  class  of  hospitals  endeavor  to  apply  real  scien- 
tific means  of  treatment  and  study  of  these  cases,  much  the 
same  as  in  other  cases  of  insanity. 

The  second  class  combine  and  treat  these  cases  with 
other  mental  diseases,  without  any  special  study  or  recogni- 
tion of  tiieir  nature  or  character. 

The  first  persons  who  come  to  these  asylums  are  the  in- 
curables. They  clamor  most  importunately  for  help.  They 
are  the  credulous,  emotional  incurables,  who  have  signed 
pledges,  joined  churches,  and  tried  every  means  known, 
and  now  expect  from  the  asylum  some  miraculous  power  of 
restoration.  In  a  few  weeks  they  believe  themselves  fully 
recovered,  and  go  away  only  to  relapse  again   and  become 


218  DISEASES    OF    INEBRIETY. 

bitter  enemies  of  the  institution.  This  class  appear  every- 
where as  examples  of  the  failure  of  the  liospitals.  An- 
other class  of  incurables  come  from  the  better  ranks  of 
society,  often  for  the  purpose  of  accomplishing  some  object, 
consent  to  go  anywhere  and  do  anything  that  promises 
relief  or  restoration.  These  moral  paralytic  inebriates 
rouse  the  highest  expectation  and  greatest  enthusiasm  in 
the  grand  work  of  asylum-cure  among  their  friends,  and 
pose  as  examples  of  "  brands  rescued  from  the  burning," 
then  suddenly  relapse  and  condemn  the  asylum  and  man- 
agement as  the  cause.  The  humbug  of  the  asylum,  its 
frauds  and  deceptions,  are  themes  of  great  relish  and  pleas- 
ure to  them, 

A  second  class  of  persons  are  coming  in  greater  numbers 
every  year  to  these  asylums.  They  are  the  cuiable  cases, — 
the  nerve  and  brain-exhausted  men  and  women,  the  large 
and  ever-increasing  class  of  business  and  professional  men, 
who  have  broken  down  from  overwork,  worry,  and  irregu- 
larity of  life  and  living,  and  who  find  alcohol  a  narcotic  of 
most  seductive  nature.  The  still  laiger  class  seen  in  every 
city  of  the  land,  who  from  brain  strains  and  drains  incident 
to  the  rushing,  grinding  civilization  of  to-day,  also  to  the 
struggle  for  position,  wealth  and  power,  and  tiie  effort  to 
adapt  themselves  to  the  new  conditions  of  life,  to  the  new 
demands,  thus  prepare  the  soil  by  exhaustion,  and  encourage 
the  growth  of  inebriety  and  its  allied  diseases.  This  class 
often  represents  the  highest  talent  and  genius,  and,  as  a 
rule,  are  the  active  brain-workers  of  the  times.  An  ine- 
briate hospital  to  this  class  is  almost  an  "  el  dorado."  It 
brings  rest,  restraint,  seclusion,  building-up,  and  is  literally 
a  place  for  repairs  and  restoration. 

In  this  class  the  use  of  alcohol,  opium,  or  any  other  nar- 
cotic is  often  more  of  a  symptom  of  exhaustion  and  debility, 
for  which  rest  and  medical  care  are  essential.  There  are 
many  thousands  of  this  class  who  could  be  saved  and  perma- 
nently restored   to   temperate  life  and  living  if  they  could 


ASYLUMS    AND    THEIE   WORK.  219 

be  placed  in  inebriate  hospitals  and  treated  early.  Later, 
they  become  clironic  and  incurable,  and  are  ever  after  a 
burden  and  heavy  loss  to  the  world.  To-day  they  cannot 
go  to  an  insane  asylum,  and  tlie  public  hospital  is  unfit  for 
them,  and  no  place  is  open  adapted  to  reach  tiieir  wants. 

A  large  army  of  tliese  curable  cases  are  scattered  in 
ever)^  community,  and  in  almost  every  home;  and  are  the 
skeletons  which  haunt  and  peril  the  peace  of  many  house- 
holds. They  are  tlie  secret  and  moderate  drinkers.  They 
are  those  who  have  secret  or  open  drink  paroxysms,  and 
who  recover  only  to  relapse  again  whh  steady  increasing 
frequency.  Both  men  and  women  in  all  circles  of  life  are 
found  in  this  army  of  dissolution.  Moral  remedies  fail, 
religion  fails,  they  go  steadily  down  and  soon  all  fears  of 
publicity  are  thrown  aside,  and  the  march  to  death  is  rapid 
and  distinct.  Not  far  away  in  the  future,  asylums  and 
hospitals  will  be  opened  to  save  these  cases,  and  public 
sentiment  will  demand  that  they  be  placed  under  treatment 
early  in  the  progress  of  the  case.  Of  this  class  a  very 
large  number  are  curable,  and  all  are  benefited  by  hospital 
residence. 

A  third  class  comprises  the  erratic  border  liners,  or  per- 
sons who  alternate  up  and  down  the  line  of  sanity  and 
insanity,  whose  genius  attracts  by  its  glitter,  and  bewilders 
by  its  weakness.  They  sound  the  praises  of  the  asylum  far 
and  near,  exaggerate  its  power,  and  claim  the  most  extra- 
ordinary results,  then  rush  to  tiie  other  extreme  on  relaps- 
ing, exliibiting  a  malice  and  pleasure  in  destroying  what 
they  so  lately  praised. 

Others  who  are  less  incurable  appear,  but  always  wish 
to  decide  the  lengtii  of  tiieir  treatment,  then  go  away  only 
to  relapse  and  attribute  the  failure  to  the  asylum.  In 
addition  to  all  this,  public  sentiment  often  gives  credit  to 
these  statements  of  incurables,  and  hence  withholds  the 
sympathy  and  aid  wiiich  should  be  given.  In  many  cases 
the  State  refuses  to  give  only  limited  authority  to  the  man- 


220  DISEASES    OF   INEBRIETY. 

agers  to  hold  patients.  And  in  other  cases  the  clergy  and 
temperance  reformers  insist  tliat  prayer,  conversion,  and 
the  pledge  shall  be  made  prominent  in  the  treatment. 

Thus  tlie  most  extraordinary  misrepresentations,  extrav- 
agant credulity,  and  ignorant  criticism  follows  every 
movement  of  the  institution.  The  superintendent  and  the 
managers  are  never  able  to  carry  out  their  plans  fully,  or 
bring  out  the  real  object  and  methods  of  obtaining  it  with 
these  cases. 

The  results  of  treatment  in  a  few  scientific  hospitals  for 
inebriates  are  most  encouraging.  The  first  statistical  study 
was  made  at  Binghamton  Asylum  in  1874.  The  object  was 
to  find  out  how  many  persons  who  had  been  under  treat- 
ment continued  temperate  years  after.  Accordingly,  over 
a  thousand  circular  letters  were  addressed  to  friends  of 
patients  who  had  been  under  treatment  five  years  before, 
asking  the  present  condition  of  the  patient.  The  answers 
indicated  sixty-two  and  a-half  per  cent,  as  yet  temperate 
and  total  abstainers.  This  result,  after  an  interval  of  five 
years,  was  clear  evidence  that  a  large  per  cent,  would  remain 
cured  during  the  remainder  of  life. 

Dr.  Day,  of  Washingtonian  Home,  made  a  similar  study 
of  eight  thousand  cases  who  had  been  under  treatment  ten 
to  eighteen  years  before,  and  found  over  thirty-eight  per 
cent,  yet  sober  and  temperate.  Dr.  Mason,  of  King's  County 
Home,  examined  two  thousand  cases  who  had  been  away 
from  the  asylum  for  ten  years,  and  found  thirty-six  per 
cent,  of  all  cases  yet  cured.  Other  observers  have  made 
studies  of  a  smaller  number  of  cases  with  similar  results. 

Not  less  than  two  thousand  inebriates  are  under  treat- 
ment in  hospitals  in  America.  Over  a  thousand  of  this 
number  are  in  special  hospitals.  They  represent  most 
largely  the  incurable  cases  ;  persons  who  have  tried  every 
means  found  in  the  pledge,  prayer,  and  by  moral  suasion, 
and  exhausted  every  resource  of  home  and  friends,  and 
come  as  a   last  resort,  expecting  extraordinary  change  and 


ASYLUMS    AND    THEIR     WOKK.  221 

cure.  Tliey  have  been  victims  of  this  disease  from  five  to 
thirty  years,  and  present  tlie  most  complex  and  varied  de- 
grees of  physical  and  mental  degeneration.  Yet,  notwith- 
standing this  fact,  the  experience  of  the  few  scientific  hos- 
pitals in  the  results  of  treatment  is  exceedingly  promising. 
Statistics  of  over  three  tliousand  cases,  wliich  have  been 
under  treatment  at  different  hospitals,  indicate  nearly  forty 
per  cent,  restored  and  temperate  after  a  period  of  six  to 
eight  years  from  the  time  of  discharge  from  the  hospital. 
The  best  authorities  unite  in  considering  thirty-five  per 
cent,  of  all  who  remain  under  treatment  one  year  or  more 
as  permanently  restored.  In  view  of  the  chronic  character 
of  these  cases,  and  the  imperfect  means  of  treatment,  these 
statistics  are  encouraging,  and  indicate  great  possibilities  in 
the  future  from  a  better  knowledge  and  control  of  these 
cases. 

Legal  Control  of  Inebriates. — The  legal  control  of  the  ine- 
briates in  America,  and  legislation,  are  very  imperfect.  In 
Connecticut  the  best  laws  are  in  force,  giving  power  over 
inebriates  to  voluntarily  commit  themselves,  or  be  com- 
mitted by  tiieir  friends,  without  the  formality  of  appearing 
before  a  judge  or  court.  In  other  States  they  are  com- 
mitted to  asylums  in  about  tlie  same  way  as  the  insane 
are.  In  the  hospitals  they  are  controlled  legally  the  same 
as  the  insane,  only  with  more  difficulty,  and  the  constant 
intrusion  of  disputed  questions  of  authority  which  cannot 
be  settled.  Nearly  all  the  leading  hospitals  have  special 
powers  of  control,  which  they  exercise  with  caution  in  most 
cases.  But  generally  both  legislation  and  legal  authority 
are  not  far  ahead  of  public  sentiment,  and  hospital  managers 
are  unwilling  to  go  beyond  this.  Most  of  the  hospitals 
have  power  to  control  patients  a  certain  specified  time, 
agreed  upon  when  admitted  to  the  hospital. 

But  apart  from  the  view  tiiat  special  retreats  are  neces- 
sary for  the  sake  of  inebriate  patients,  I  would  urge  their 
estabiisiiment     in     order    to    relieve    the    families    of   such 


222  DISEASES   OF   INEBRIETY. 

patients  of  the  burden  of  maintaining  them.  I  know  of 
many  instances  where  tlie  wife  could  provide  for  herself 
and  children,  but  an  attack  of  inebriety  in  the  husband 
tlirows  all  back.  He  must  be  watched  day  and  night  while 
tlie  attack  lasts,  medical  attendance  and  medicines  must  be 
procured,  the  siiop  or  the  sewing  which  would  otherwise 
bring  in  enough  to  keep  them  is  necessarily  neglected,  and 
slie  is  obliged  again  and  again  to  appeal  to  friends,  who 
begin  to  get  weary  of  giving  assistance.  The  poor  wife 
says:  "  Something  must  be  done;  he  must  be  put  some- 
where ;"  but  the  prospect  of  prison  or  of  the  lunatic  asylum 
deters  her  from  taking  any  action,  and  she  says  :  "Well,  I 
will  give  him  another  trial."  Tiiese  poor  women  have  bitter 
lives,  and  many  of  them  make  noble  sacrifices  for  the  sake 
of  their  families.  The  State  ought  to  afford  them  a  ready 
means  of  relief  from  the  consequences  of  a  physical  and 
mental  disease  in  their  husbands  for  which  they  are  in  no 
way  responsible. 

I  would  then  propose  the  establishment  of  hospitals  for 
the  care  and  cure  of  inebriates,  such  hospitals  to  be  either 
supported  by  the  State,  or  else  under  State  inspection  and 
control.  That  persons  suffering  from  inebriate  disease 
should,  if  the  outbreak  of  the  disease  be  recent,  on  the  rep- 
resentation of  their  friends  to  a  magistrate,  and  after  due 
examination  by  medical  men  and  proper  certificates  being 
signed  by  them,  be  committed  to  one  of  the  hospitals  for 
nervous  diseases  for  a  j'ear.  That  the  period  of  detention 
in  such  hospital  might  be  lessened  on  the  recommendation 
of  the  medical  ofiiceis.  That  during  the  patient's  residence 
in  such  institution  he  should  be  obliged  to  do  sufficient 
work  to  pay  the  expenses  of  his  living,  and  the  surplus  to  be 
lianded  to  iiis  friends  for  his  support  on  his  discharge.  The 
object  of  the  work  would  not  be  merely  to  pay  expenses, 
but  to  give  healtiiy  mental  and  bodily  occupation  ;  to  sub- 
stitute healthy  nerve-work  for  unhealthy  impulses,  and  thus 
to  act  curatively.     In  cases  where  such  seclusion  and  abstin- 


ASYLUMS    AND  THEIR    WORK.  223 

ence  from  alcohol  for  a  year  had  been  tried  without  effect 
— that  is,  in  cases  of  presumed  incorrigible  drink-mania — 
the  patient  should,  on  each  outbreak,  if  not  under  proper 
care  and  control,  be  admitted  for  treatment  until  the  attack 
should  be  over,  and  he  should  be  detained  as  long  as  the 
medical  officers  thought  fit  with  regard  to  his  safety. 

I  have  explained  what  proper  care  and  control  means, 
but  will  do  so  again.  It  means  such  care  as  will  prevent 
the  patient  getting  alcohol  during  the  attack — an  exceed- 
ingly difficult  measure  to  carry  out  in  private  houses.  I 
would  avoid  the  use  of  the  word  "  asylum,"  and  name 
an  institution  for  the  treatment  of  inebriates  "  Hospital  for 
Disease  of  the  Nervous  System."  It  could  easily  by  speci- 
fied in  the  rules  of  the  hospital  for  which  particular  nervous 
disease  it  was  intended.  Such  a  name  would  be  less  repug- 
nant to  the  patient  than  the  word  "  asylum,"  and  would 
serve  to  educate  public  opinion.  The  establishment  of  such 
State  hospitals  might  be  objected  to  on  the  score  of  cost, 
but  it  must  be  evident  that  the  community  pays  far  more 
heavily  by  the  present  system,  or  want  of  system,  than  it 
would  do  if  special  hospitals  were  established.  We  should 
then  be  saved  the  expense  of  maintaining  such  patients  in 
prison  ;  and  such  special  hospitals  could  be  made  self-sup- 
porting to  a  very  great  extent,  rendering  the  estates  of  those 
who  were  able  to  pay  liable  for  their  maintenance,  while  the 
others  should  work  for  their  support.  Inebriates  who  might 
be  allowed  to  live  out  of  the  retreat  on  parole,  could,  if  they 
broke  their  parole,  be  treated  in  the  nearest  public  hospital 
and  discharged  when  the  fit  was  over  ;  but  if  they  again 
broke  out  they  could  be  committed  to  the  retreat  for  the 
full  time  on  the  recommendation  of  the  medical  officers, 
without  option  of  leaving  until  their  time  should  have 
expired. 

Dr.  Day,  of  Washingtonian  Home,  makes  the  following 
clear  and  positive  statement  of  results.  Twenty-two  years 
of  experience  in  this  work    has   demonstrated  that  the  task 


224  DISEASES   OF   INEBRIETY. 

is  neither  hopeless  nor  thankless  ;  nor  would  it  be  if  the 
measure  of  success  had  been  lessened  one-half  from  the 
known  rate  of  percentage  of  cures.  I  know  of  no  hospital, 
infirmary,  or  reformatory  institution  in  the  country — and  I 
may  as  well  say,  in  the  world — in  which  the  proportion  of 
cures  to  the  number  of  patients  treated  is  greater  than  it 
has  been  annually  in  this  Institution,  from  the  date  of  its 
origin  down  to  tiie  present  time. 

A  variety  of  circumstances  beyond  our  control  prevents 
us  from  making  a  fair  and  just  exhibit  of  our  success  to  the 
world.  A  man  will  go  to  the  hospital  or  infirmary  with  a 
disease  or  a  broken  limb,  and  when  healed,  or  made  whole, 
there  is  no  hesitancy  or  delicacy  on  his  part,  or  with  his 
friends  and  relatives,  in  making  the  fact  generally  known  ; 
sometimes,  especialh'^  when  the  patient  is  of  sufficient  conse- 
quence, the  community  will  acquire  this  information  from 
the  public  prints.  But  it  is  different  with  the  recovered  ine- 
briate, who,  for  his  own  or  family  reasons,  shrinks  from  a 
confession  of  his  case,  and  while  he  rejoices,  and  is  thankful 
and  grateful  for  his  cure,  has  a  natural  repugnance  to  ac- 
knowledge tliat  he  actually  needed  the  treatment  he 
received.  Hence  it  is,  that  numbers  of  men  are  reformed  at 
the  "  Home"  who  return  to  their  families  and  to  their  busi- 
ness, giving  joy  to  friends  and  neighbors,  not  one  in  ten  of 
whom  know  how  or  where  the  sudden  change  was  wrought. 

As  a  rule,  failures  occur  with  persons  who  are  willing  to 
be  cured  if  it  can  be  done  without  making  any  sacrifice  or 
concession  themselves  towards  effecting  such  a  consumma- 
tion. However  honest  their  desires  may  be  to  live  soberly, 
they  have  not  strength  of  will  sufficient  to  resist  strong  and 
repeated  temptation.  Is  not  this  the  case  with  transgres- 
sors of  every  physical,  moral,  and  Christian  law  ?     .     ,     . 

But  even  such  cases  are  not  without  hope.  Proper 
medical  and  dietary  treatment  may  do  much  to  build  and 
strengthen  their  physical  system,  but  what  they  need  most 
is  medicine  for  a  diseased  and  weakened  mind,  and  that  is  a 


ASYLTJMS    AND   THEIR   WORK.  225 

curative  agent  not  to  be  found  in  a  drug  store  or  a   physi- 
cian's medical  case. 

In  most  cases  a  longer  lapse  of  time  is  required  to  efTect 
a  cure  than  the  patient  thinks  he  can  spare  from  liis  busi- 
ness, or  afford  to  pay  for.  The  deaf,  the  hime,  the  blind, 
and  the  sick,  who  satisfy  themselves  with  one  or  two  visits 
from  tiie  piiysician,  when  their  several  cases  require  a 
patient  and  lengthened  treatment,  have  just  the  same  right 
to  declaim  against  the  efficacy  of  medicine  and  surgery,  as 
the  public  have  to  charge  us  with  failure  in  cases  where  we 
liave  been  permitted  to  treat  only  for  days,  when  we  should 
have  had  weeks,  and  weeks  when  months  were  fairly  re- 
quired. 


CHAPTER  XXIII. 

HYGIENIC  AND  HOT  AIR  TREATMENT  OF  INEBRIETY. 

There  are  two  classes  of  drunkards  to  be  found  in  the 
United  States — one  class  are  drunkards  because  of  their 
training  and  education  ;  the  other  class  is  born  with  a  ten- 
dency to  drunkenness.  Let  me  call  attention  first  to  begot- 
ten drunkards.  These  are  peculiar.  At  the  time  of  their 
conception  the  father  and  mother  were  habituated  either  in 
their  foods  or  drinks  to  the  use  of  some  form  of  stimulants  ; 
not  necessarily  were  these  alcoholic  or  fluid  in  their  nature. 
Stimulants  are  substances  which  contain  in  their  constituent 
elements  properties  that  when  taken  into  the  human  stom- 
ach by  eating  or  drinking  have  a  specific  effect  on  the  nerv- 
ous system,  exciting  the  heart  to  undue  action,  and  through 
it  the  whole  circulatory  system,  insomuch  that  the  person 
thus  affected  takeS  on  an  unnatural  condition  of  the  vital 
organs,  by  which  he  is  subjected  to  extraordinary  activity 
of  such  organs. 

This  condition,  continued  long  enough,  becomes  habit- 
ual, and  under  it  no  person  can  go  into  the  procreative  act 
without  carrying  over  to  the  offspring  a  constitutional  dia- 
thesis or  habit  of  body,  or,  in  other  words,  a  tendency  or 
predisposition  to  the  use  of  stimulants. 

The  child  thus  made  up  has  in  him  a  need  for  stimu- 
lation in  order  that  the  vital  organs  may  perform  their 
work  to  the  best  advantage,  and  there  will  be  failure  in 
their  action  unless  this  need  be  supplied.  The  child  maj 
linger  along,  being  feeble  ;  but,  if  his  habits  are  such  as  are 
common  to  the  children  of  our  country,  he  will  die  unless 
help    is    given    him    through    stimulation.     A  physician,  if 

227 


228  DISEASES   OF   INEBRIETY. 

called  to  such  a  child,  would  almost  surely  discern  the  need 
of  extrinsic  aid  being  furnished,  in  order  that  the  vital 
organs  might  perform  their  functions  with  sufficient  direct- 
ness and  vigor  to  result  in  good  iiealth  and  continued  life. 

Under  such  circumstances,  how  is  a  person  to  be  kept 
from  becoming  a  drunkard  ?  That  is  a  problem  which 
science  and  morality,  separate  and  together,  have  been 
unable  to  solve  hitherto,  and  will  be  unable  so  long  as 
persons  permit  themselves,  wliile  under  habitual  stimula- 
tion, to  beget  and  give  birth  to  children.  It  is  not  at  all 
necessary,  in  order  that  a  child's  organization  shall  have 
such  idiosyncrasy  as  to  call  for  and  require  stimulants,  that 
either  of  the  parents  shall  be  drinkers  of  alcoholic  liquors. 
It  is  enough  that  through  food  eaten  or  medicines  taken, 
stimulants  are  constantly  introduced  into  their  circulation. 
Nature,  in  her  great  organic  processes,  knows  nothing  of,  nor 
cares  anything  about,  the  particular  substances  a  person 
uses  whereby  his  whole  system  is  extraordinarily  excited. 
It  answers  all  evil  purpose  that  this  excitement  of  the  nerv- 
ous svstem  is  created  and  constantly  kept  up.  A  married 
pair  can  give  birth  to  children  in  whom  shall  inhere  a 
tendency  to  demand  stimulation  to  that  degree  that  a 
clamor  for  it  is  set  up  in  the  very  center  of  their  bodies, 
just  as  surely  by  the  eating  of  stimulating  food  as  by  the 
drinking  of  stimulating  drinks. 

Of  begotten  drunkards  the  numbers  in  this  country  are 
larger  by  far  than  are  the  numbers  of  trained  and  educated 
drunkards.  There  are  but  very  few  children  now-a-days 
who  have  not  in  them  a  natural  desire  for  stimulants. 
Denied  these  in  every  form,  they  put  forth  but  feeble 
growth,  and  in  many  ways  show  inefficiency  in  the  perform- 
ance of  those  bodily  functions  which  must  be  fully  and 
fairly  exercised  in  order  to  the  production  of  good  health. 

Here,  then,  is  an  evil  of  great  magnitude  which  is  not 
touched  at  all  by  any  temperance  movement  yet  inaugurated, 
and  herein  lies  the  secret    of  the  imperfect    success  of  all 


HYGIENIC   AND   HOT   AIR   TREATMENT.  229 

such  movements.  Little  or  nothing  is  gained  as  respects 
the  arrest  and  overthrow  of  intemperance  while  the  cliildren 
who  come  into  the  world  have  not  only  a  natural  liking  for 
liquor,  but  have  also  what  may  be  called  a  natural  need  for 
it.  Every  generation  repeats  the  story  of  its  predecessor. 
As  the  child  grows  up  his  liking  for  stimulants  takes  on  the 
form  of  a  need  for  them.  When  puberty  is  reached,  the 
boy,  whose  activities  are  tlien  drawn  upon  more  largely  and 
decidedly  than  at  any  previous  period,  finds  that  to  answer 
to  the  simple  nutrient  wants  of  his  system,  so  far  as  muscu- 
larity is  concerned,  does  not  meet  his  necessities.  He  may 
be  in  good  muscle  and  so  of  good  size  of  body,  but  there  is 
a  defect  in  him  not  to  be  overcome  by  force  of  will  when  he 
is  called  upon  to  show  large,  well-directed,  and  successful 
energy.  He  lacks  just  at  this  point  the  agency  by  which 
energy  alone  can  be  developed,  and  if  he  cannot  have  aid 
he  fails. 

It  is  this  cry  in  his  body  for  stimulation,  for  something 
to  innervate  him  and  make  him  feel  strong,  that  sets  him  to 
drinking  ;  and  this  clamor  is  just  as  likely  to  be  manifested 
if  his  father  and  motlier  are  total  abstainers  from  all  intoxi- 
cating drinks  as  though  they  indulged  habitually  in  them. 
Total  abstainers  from  these  drinks,  who  do  not  abstain  from 
other  stimulants,  may  use  them  to  a  degree  and  in  a  measure 
that  will  produce  quite  as  deleterious  effects  on  the  nervous 
system  as  would  be  produced  by  drinking  alcoholic  bever- 
ages. So  the  cliild  born  of  parents  who  are  pledged  to  the 
entire  disuse  of  intoxicating  liquors,  may  have  a  natural 
desire  or  need  for  alcoholic  stimulants,  as  truly  as  the  child 
born  of  parents  whose  nervous  systems  have  been  habitually 
excited  by  alcohol. 

The  object  tlien  to  be  sought  must  be,  not  the  exchange 
of  stimulants,  but  tlie  abandonment  of  them  altogether. 
Then  cliildren  will  be  brought  to  birth  with  no  tendency  in 
them  to  the  use  of  stimulants,  and  then  they  can  be  trained 
up  and  reared  along  a  line  of  sobriety  and  abstinence  from 


230  DISEASES    OF   INEBRIETY. 

all  Stimulants,  which  will  make  it  quite  out  of  the  question 
that  they  should  ever  use  intoxicants  in  any  form. 

There  is  a  process  by  which  a  child  with  an  inborn  need 
for  stimulants,  in  order  to  make  his  organs  perform  their 
natural  functions,  can  be  reconstitutionalized.  That  pro- 
cess involves  freedom  from  taxation  of  tlie  nervous  system 
for  years  after  his  birth.  The  child  lias  to  be  cared  for  and 
looked  after  like  a  young  animal.  The  developments  that 
need  to  be  made  in  him  are  such  as  affect  tlie  nutritive 
nervous  system.  He  should  be  kept  free  from  all  cerebral 
excitement.  He  needs  to  be  cared  for  by  judicious  and 
wise  nurses.  He  cannot  be  permitted  to  eat  or  drink,  nor 
do  or  be,  as  children  usually  are. 

If  he  were  thus  related  to  life  he  would  die  ;  but  if  he 
can  be  kept  free  from  all  unnecessary  excitement  of  brain 
and  be  handled  with  close  watclifulness  for  the  first  three 
or  four  years  of  his  life,  his  relations  to  vital  development 
will  become  greatly  changed,  and  from  that  point  on,  the 
reconstructive  processes,  so  well  begun,  will  proceed  to  com- 
pleteness. He  will  ultimately  reach  a  condition  of  his 
nervous  organization  where  he  will  no  longer  need  stimula- 
tion. 

Till  that  is  accomplished,  attention  must  be  given  to  him 
or,  with  no  stimulants  administered  in  his  food  or  drink,  he 
will  fade  away  and  die.  It  is  most  unfortunate  that  a  child 
should  be  made  up  in  a  state  of  dependency  upon  factitious 
aids,  but  where  such  dependency  exists,  reconstructive  meas- 
ures can  be  instituted  and  made  effectual.  This  I  have 
proved  on  tiiis  Hillside  to  the  satisfaction  and  joy  ofagieat 
many  parents.  The  better  way,  however,  is  to  forestall  such 
an  issue  as  this,  and  not  have  children  begotten  when  the 
parents  are  under  a  bodily  habitude  of  subjection  to  stimu- 
lation. 

For  a  long  time  I  have  been  convinced  that  the  present 
temperance  reformation  is  radically  inefificient.  Theunphilo- 
sophical  aspect  of  it  will  have  to  give  way  before  a  broader 


HYGIENIC    AND    HOT    AIR   TREATMENT.  231 

and  more  effective  effort,  or  we  shall  liave  to  keep  it  up  for- 
ever, having  in  each  succeeding  generation  as  many  or  more 
persons  becoming  drunkards  as  in  generations  preceding. 

The  second  class  of  drunkards — those  who  are  made  so 
by  education  and  training — are  persons  not  born  with  a 
constitutional  necessity  for  the  use  of  stimulants.  As  chil- 
dren they  do  not  in  our  country  constitute  a  very  large  class. 
They  never  need  be  drunkards.  Tiie  temptation  to  drink  is 
not  in  their  bodily  constitution.  It  lies  in  society  in  some 
or  other  of  its  forms  of  associations.  Thrown  into  good 
and  upright  relations  from  childhood,  they  will  not  become 
drunkards.  They  will  not  even  drink  liquors  moderately. 
As  they  develop  into  intelligence  and  moral  sense,  they  will 
see  that  the  use  of  stimulants  for  purposes  of  exiiilaration, 
or  of  innervation  of  the  nervous  system,  is  not  good  for 
them.  They  will  be  ready  to  join  the  total  abstinence 
ranks,  and  when  they  have  joined  them,  they  will  stand 
true. 

But  out  of  this  class  there  is  a  certain  number  who  do 
become  drunkards.  These  lack  the  early  training  and  right 
association  and  proper  surroundings.  They  eat  highly 
stimulated  foods  and  drink  stimulo-narcotic  drinks,  like  tea 
and  coffee,  until  they  have  created  in  them  an  abnormal 
desire  for  things  that  are  exciting.  No  person  can  habitu- 
ally eat  largely  of  the  indiscriminate  foods  used  in  most 
families,  and  drink  such  beverages  as  are  there  daily 
imbibed,  without  after  awhile  coming  to  have  a  longing  for 
stimulation.  Young  persons  come  to  have  a  want  for  some- 
thing stronger  than  tea  or  coffee,  and  many  of  them  have 
opportunity  at  the  home  table  to  indulge  in  the  milder 
forms  of  alcoholic  drinks.  So  they  go  on  from  bad  to 
worse  and  from  worse  to  worst.  Out  of  this  class  a  certain 
proportion  become  drunkards  and  once  they  are  habitually 
inebriated,  their  restoration  to  permanent  sobriety  is  as  dif- 
ficult as  though  they  belonged  to  the  first  class. 

This  cure  does  not  lie  with   certainty  in  any  movement 


232  DISEASES    OF   INEBRIETY. 

which  simply  makes  its  appeal  to  the  moral  sense.  A 
drunkard  may  be  said  to  have  no  moral  sense.  He  has  a 
physical  sense  and  he  has  a  social  sense.  His  physical  sense 
tends  directly  to  keep  him  a  drunkard.  His  social  sense 
may  work  for  his  recovery.  He  may  be  so  situated  that 
social  influences  shall  operate  to  induce  him  to  sign  a  pledge 
that  he  will  not  drink  any  more,  and  here  and  there  may  be 
found  one  out  of  a  great  many  who  will  keep  such  a  pledge, 
not  by  reason  of  any  inherent  strength  which  he  himself  has 
whereby  to  keep  it,  but  by  reason  of  the  outside  influences 
which  affect  him  and  the  watch-care  which  is  had  over  him. 

If  thinking  men  and  women  will  take  pains  to  investigate 
this  matter  as  thoroughly  as  I  have  done,  they  will  see  that 
a  very  large  proporiion  of  the  whole  number  of  drunkards  in 
this  country  is  made  out  of  the  class  which  is  born  with  a 
liking  for,  with  a  tendency  to,  and  with  a  need  of,  the  use  of 
stimulants. 

It  is  now  coming  to  be  recognized  that  inebriety  is  a 
disease,  but  its  treatment  has  heretofore  been  too  much 
relegated  to  the  moralist  instead  of  the  physician  to  whom 
it  properly  belongs.  The  moralist  has  given  us  theories  as 
to  its  cause  and  cure,  but  the  theories  have  brought  us  no 
advancement  ;  the  disease  still  remains  to  vex  their  patient 
souls.  The  medical  profession,  however,  place  this  subject 
in  its  true  ligiit,  and  give  aliope  to  the  world  that  in  a  short 
time  there  will  be  a  better  way  to  handle  this  whole  matter. 
Dr.  Wright  most  forcibly  says  :  "Drunkenness  is  in  every 
essential  particular  a  condition  of  civil  death,  and  it  would 
seem  best  that  it  should  be  so  construed  by  the  law  of  the 
land."  Society  should  be  protected  from  the  habitual 
drunkard,  and  especially  should  he  be  protected  from  him- 
self. To  my  mind  the  bane  of  the  age  is  excessive  alimen- 
tation, leading  up  to  a  desire  for  stimulants,  which  is 
'  naught  but  a  morbid  craving,  and  in  ignorant  hands  stim- 
ulation is  supposed  to  ward  off  its  consequences. 

On  the  contrary,  and  in  reality,  the  use  of  stimulants  at 


HYGIENIC   AND   HOT   AIR   TREATMENT.  233 

such  times  induces  a  condition  of  internal  inflammation 
that  increases  the  desire  for  further  stimulation,  and  also 
the  inability  to  properly  dispose  of  whatever  aliment  may 
be  present,  thus  effectually  rendering  a  bad  matter  worse. 
We  well  know  that  nothing  will  so  speedily  subdue  the 
nervous  storm  as  the  ever  convenient  and  alluring  alcohol. 
It  is  sought  to  give  insensibility  to  nerve  agony,  and  secures 
for  a  time,  rest  and  repose,  but  the  wear  and  tear  of  this 
oft  repeated  nerve  strain  is  frequently  shown  in  paralysis 
and  sometimes  insanity.  Perliaps  the  most  serious  effect  of 
alcohol  is  its  direct  tendency  to  interfere  with  nutrition, 
and  by  promoting  growth  of  cellular  tissue  to  compromise 
the  integrity  of  the  brain  tissue  where  the  poison  is  not 
readily  thrown  off,  and  where  it  soon  destroys  not  only  its 
co-ordinating  power,  but  degenerates  the  brain  substance. 
Inasmuch  as  the  mental  and  moral  character  of  the  individ- 
ual depends  upon  the  action  of  the  brain  itself,  we  cannot 
look  for  good  results  when  there  is  any  impairment  of  its 
substance  ;  on  the  contrary,  we  often  see  the  worst  results 
from  such  a  condition. 

The  impairment  of  consciousness  is  only  one  of  the  many 
forms  by  which  the  influence  of  alcohol  is  felt,  and  suggests 
the  question  whether  we  have  any  process  whereby  its 
elimination  may  be  successfully  secured.  We  also  know 
that  with  tlie  inebriate  thei-e  is  a  lack  of  fine  moral  sense, 
not  infrequently  amounting  to  obtuseness,  and  that  this 
condition  is  far  reaching,  affecting  even  the  progeny,  thus 
making  it  hereditary.  If  there  is  a  process  whereby  the 
blood  itself  can  be  purified,  we  may,  witli  every  reason, 
expect  tlie  brain  tissues  to  participate  in  the  advantages 
derived  tlierefrom,  and  consequently  we  will  have  greater 
clearness  of  perception,  followed  by  a  quickened  moral  sense. 
The  irresistible  impulse  of  our  modern  civilization,  from 
infancy  to  old  age,  is  push,  and  the  mental  and  physical 
powers  alike  suffer  in  tlie  long  run.  The  free  use  of  alcohol 
is  accountable  for  a  large  measure  of   this  condition.     Can 


234  DISEASES    OF    INEBRIETY". 

we  not  teach  the  people  to  give  more  time  to  rest  and 
recuperation  and  less  to  stimulation  ?  If  it  is  wished  to 
place  tiie  inebriate  in  the  condition  most  favorable  for  cure, 
it  is  important  that  there  should  be  institutions  created  for 
that  purpose. 

Granting  that  inebriety  is  a  disease,  our  efforts  should 
be  to  eradicate  that  disease,  and  in  order  to  do  so,  there 
must  necessarily  be  desirable  sunoundings  as  well  as  con- 
trol over  the  patient.  The  model  institution  is  yet  to  be 
built,  wherein  the  hot-air  bath  shall  hold  a  pre-eminent  po- 
sition, where  narcotics  shall  be  entirely  disallowed,  even 
though  it  may  be  an  improvement  on  inebriism  to  have  one's 
system  saturated  and  senses  blinded  by  narcotism,  and  when 
there  shall  be  enough  control  to  prevent  any  dallying  with 
the  tempters.  The  theory  of  the  action  of  the  hot-air  bath 
is  very  simple.  Like  the  action  of  the  sun's  rays  upon 
Bunker  Flill  Monument  when  shining  upon  one  side  and 
causing  it  to  lean  toward  the  other,  so  does  this  agent  act 
gently  and  yet  powerfully.  The  primary  action  of  heat, 
which  is  the  one  essential  thing  of  the  Turkish  bath,  is  to 
relax  the  tissues  of  the  body  and  thus  invite  a  more  perfect 
circulation  to  every  part  of  the  system  ;  by  a  more  active 
circulation  every  sense  is  quickened — the  secretions  are 
more  thorough,  the  excretions  more  perfect,  the  blood  is 
better  supplied  with  oxygen — the  skin  assumes  its  natural 
roseate  complexion,  indicative  of  the  improved  condition, 
and  each  and  every  function,  whether  it  be  that  of  the  lungs 
liver,  spleen,  or  bowels,  comes  in  for  its  share  of  the  general 
benefit — in  a  word,  it  opens  every  pore  of  the  skin,  and  hence, 
the  most  perfect  sewage  to  the  body  The  secondary  action 
is  tiiat  of  profuse  sweating — where  water  from  the  blood 
and  debris  or  used-up  tissue  and  poison  held  in  solution  are 
rapidly  thrown  out  of  the  body. 

According  to  recorded  observation,  "the  quantity  of 
blood  in  the  body  is  lessened  by  tlie  free  excretion  which 
takes  place  through  the  skin  and  lungs  ;  the  body  weight  is 


HYGIENIC    AND    HOT   AIR   TREATMENT.  235 

reduced,  and  the  work  of  tlie  heart  in  this  way  liglitened,  at 
tlie  same  time  that  its  substance  is  better  nourislied  by  the 
improved  quality  of  tlie  blood  supplied  to  it.  The  peripheral 
arterioles  of  the  body,  too,  become  dilated  and  filled  with 
blood,  thus  affecting  a  corresponding  emptying  of  the  blood 
vessels  of  the  internal  organs.  Lastly,  as  a  result  of  the 
alternate  warm  and  cold  douching,  the  vaso  motor  energy 
of  the  vessels  is  increased,  thus  rendering  them  more  capable 
of  resisting  any  strain  thrown  upon  them."  Thus  it  will 
readily  be  seen  how  quickl}'^  congestion,  wherever  it  may  be 
located,  is  broken  up  and  the  offending  material  thrown  out 
through  the  pores  of  the  skin.  Under  such  conditions 
absorption  and  elimination  have  their  most  perfect  oppor- 
tunity and  equalization  crowns  the  work.  It  must  be 
apparent  that  alcohol  is  soon  eradicated  from  the  system 
under  such  favorable  conditions,  and  that  torpidity  gives 
place  to  activity.  Furthermore,  no  living  tissue  or  vitality 
can  be  abstracted  by  the  process — nothing  is  thrown  off  but 
what  the  system  is  better  without.  One  bath  has  been  fre- 
quently known  to  relieve  an  intermittent  pulse,  giving  a 
smooth,  regular  action  to  the  heart,  indicating  a  well  bal- 
anced circulation.  What  known  drug  can  do  this  in  the 
space  of  half  an  iiour?  And  another  great  advantage  in 
favor  of  this  treatment  is,  that  there  is  no  poison  left  in  the 
system  to  work  its  way  out,  as  is  sometimes  the  case  when 
drugs  are  administered;  per  contra,  the  individual  is  left 
in  a  calm  and  quiet  frame  of  body,  which  necessarily  reacts 
upon  the  mind.  It  could  not  be  maintained  that  the  hot- 
air  bath  would  renew  brain  or  other  tissue  where  there  has 
been  actual  lesion,  but  it  will  place  under  most  favorable 
condition  for  repair  what  is  left,  and  then  adjacent  or  collat- 
eral parts  will  do  their  best  to  carry  on  the  work  of  the 
injured  part. 

By  placing  the  patient  in  an  institution  of  the  kind  men- 
tioned, we  at  once  completely  remove  the  cause  of  the 
disease,  and  then  with  the  bath  we  have  only  the  effects  to 


236  DISEASES   OF  INEBRIETY. 

treat.  In  the  instance  of  insanity  the  hot-air  batli  has  in  a 
large  number  of  cases  brought  relief  to  deranged  conditions 
and  given  harmony  to  disturbed  mental  functions,  and  this 
where  tiie  cause  was  present,  for  we  know  that  this  disease 
obliterates  the  patient  intellectually,  and  leaves  the  physi- 
cian in  the  dark  in  reference  to  the  cause  or  the  effect  of 
the  malady.  It  must,  therefore,  be  evident  to  every  medi- 
cal mind,  that  the  remedy  which  will  effect  every  organ  and 
create  in  it  an  action  to  throw  off  diseased  conditions,  is  the 
only  one  to  meet  sucii  cases.  With  how  much  more  reason 
must  we  expect  even  better  results  in  cases  of  inebriety, 
where  the  cause  of  the  disease  is  eliminated  and  the  advan- 
tages of  treatment  are  more  perfect.  The  mucous  surfaces 
of  the  inebriate,  and,  in  a  minor  degree,  tliose  of  the  mod- 
erate drinker,  are  in  a  chronic  state  of  inflammation.  The 
effect  of  the  hot-air  treatment  is  to  reduce  that  inflamma- 
tion by  purifying  the  blood,  thereby  relieving  that  immod- 
erate craving  for  stimulants,  tliat  only  perpetuates  and 
increases  the  disease  instead  of  giving  relief.  During  my 
long  experience  in  the  administration  of  the  Turkish  bath, 
many  persons  who  had  been  more  or  less  under  the  influ- 
ence of  alcohol,  have  expressed  to  me  in  most  unqualified 
terms  the  benefits  that  they  had  derived  from  its  use,  par- 
ticularly those  who  came  after  a  debaucli.  In  fact,  this 
has  been  thoroughly  demonstrated,  as  tiie  experience  of  all 
bath  establishments  will  testify.  Place  man  or  boy  in  a 
clean  suit  of  clothes  throughout,  and  he  will  not  only  take 
good  care  of  the  clothes,  but  also  of  himself,  and  behave 
more  discreetly  than  before. 

In  like  manner,  if  you  thoroughly  purify  a  man,  as  is 
done  by  one  of  these  baths,  he  at  once  realizes  that  he  is  a 
cleaner  man  and  on  a  higher  plane,  his  senses  are  more 
acute,  he  is  in  his  best  condition,  he  respects  himself  so  much 
the  more,  and  is  less  liable  to  return  to  his  base  practices.  It 
is  stated  as  a  fact  that  in  no  country  has  inebriety  been 
found  co-existent  with  the  bath.     Temperance  and  clean- 


HYGIENIC   AND   HOT   AIE   TREATMENT.  237 

Hness  are  its  handmaids.  This  treatment  lias  had  but  a 
limited  trial  in  this  countr\%  though  it  has  been  successfully- 
used  in  a  multitude  of  cases  in  Great  Britain,  particularly 
at  Dr.  Barter's  establishment,  near  Cork,  in  Ireland.  The 
only  demonstration  in  this  country  was  at  Binghaniton, 
during  tlie  first  three  years  of  it  administration,  in  which 
time  not  a  death  occurred  among  the  patients.  Dr.  Lees, 
says:  "In  the  case  of  persons  having  latent  cravings  for 
drink,  we  know  of  few  things  more  efificacious  than  a  short 
course  of  that  peculiar  method  of  cleansing,  which,  bor- 
rowed from  the  Orientals,  has  been  recently  introduced 
into  many  cities — we  mean  the  Turkish  bath.  Who,  suffer- 
ing from  morbid  accumulations  incident  to  town  life,  that 
has  ever  tried  these  processes,  has  not  felt  a  wonderful 
increase  in  the  vital  elasticity  of  his  frame  !  It  is  as  though 
a  heavy  weight  had  been  lifted  from  the  bent  spring  of  life, 
permitting  fuller  and  freer  play  to  the  vital  machinery  and 
creating  a  feeling  of  sympathetic  purity  in  the  soul." 

The  true  physician  stands  before  the  community  in  the 
light  of  a  teacher  as  well  as  a  healer,  and  his  opportunities 
for  usefulness  are  large  and  often  far  reaching.  Probably 
no  class  do  more  charitable  work  than  the  men  of  this  pro- 
fession. In  no  way  can  they  do  more  good  than  in  encour- 
aging both  by  example  and  precept,  those  institutions  that 
have  for  their  object  the  welfare  of  the  community,  and  no 
institution  of  modern  times  promises  so  much  to  the  mass 
of  the  people  as  the  genuine  hot-air  bath.  Sanitary  science 
is  of  incalculable  value  to  each  and  every  one  of  the  com- 
munity, for  it  deals  with  that  which  is  vital  to  the  well- 
being  of  the  whole,  but  the  hot-air  bath  is  sanitary  science, 
refined  and  brought  to  the  individual  ;  indeed  it  is  the  per- 
fection of  sanitary  science.  As  a  prophylactic,  it  stands  at 
the  head  of  all  remedies.  As  a  disinfectant,  none  with  it 
can  compare.  The  more  it  is  popularized,  the  nearer 
it  will  come  within  the  reach  of  everybody,  and  the  more 
widespread,  necessarily,  will  be  its  blessings. 


CHAPTER  XXIV. 

DUTY  OF  THE  STATE  IN  THE  CARE   AND   TREATMENT    OF 
INEBRIATES. 

The  State  assumes  the  right  to  license  reputable  men  to 
seii  alcoliolic  liquors  to  those  who  are  in  tiie  habit  of  using 
them,  to  those  who  would  like  to  experience  their  effects, 
and  to  those  who  wish  to  treat  their  friends  to  sometliing 
uncommonly  good.  This  the  State  does  in  accord  with 
tlie  laws  made  to  suit  public  opinion. 

If  tliis  "  opinion  of  the  public"  would  demand  it,  the 
State  could  very  properly  assume  the  right  to  license  opium 
dens,  or  saloons  of  euthanasia,  wiiere  a  fellow  could  shuffle 
off  this  mortal  coil  according  to  the  most  approved 
methods. 

In  other  words,  public  opinion  forms  laws,  whether  just 
or  unjust,  and  it  is  the  duty  of  all  good  citizens  to  acquiesce 
in  a  state  of  affairs  brought  about  b}'^  the  decision  of  the 
majority. 

In  a  study  of  this  topic  I  enquire,  Firsts  Has  a  man  the 
right  to  become  a  drunkard,  and  after  he  is  a  drunkard  has 
he  the  right  to  be  one  ? 

The  laws  of  the  State  permit  the  drunkard  to  be  made, 
because  tlie  State  licenses  reputable  men  to  sell  alcoliolic 
liquors  ;  and  the  laws  of  the  State  concede  the  right  to  be- 
come a  drunkard  to  every  citizen,  because  the  State  says 
that  personal  liberty  sliould  not  be  interfered  with.  On  the 
other  hand,  tlie  laws  of  the  State  direct  tiiat  the  drunkard 
be  fined  and  imprisoned  for  being  what  his  personal  liberty 
entitles   him    to    be.     It   is,    therefore,    logical    to   say,    tiiat 

239 


2J:0  DISEASES    OF    INEBRIETY. 

according  to  the  laws  of  the  State,  a  man  has  a  perfect 
right  to  become  a  drunkard,  but  that  after  lie  is  a  drunkard 
he  has  no  right  at  all  to  be  one. 

Science  claims  that  the  inebriate  does  not  exercise  his 
free  will  to  remain  or  to  be  a  drunkard,  for  the  simple 
reason  that  he  no  longer  has  a  free  will  to  exercise,  but  that 
lie  is  the  involuntary  slave  of  an  uncontrollable  desire. 
Science  also  claims  that  the  drunkard  may  have  never  exer- 
cised his  free  will  in  the  matter.  He  may  not  be  a  drunk- 
ard from  choice,  but  he  may  have  inlierited  a  predisposition 
to  become  a  drunkard,  and  necessity,  opportunity,  and 
circumstances  may  have  made  him  what  he  is,  an  habitual 
drunkard. 

Science  further  claims  that  it  has  demonstrated  that  ine- 
briety is  a  disease  ;  that  the  State  licenses  the  making  of 
this  disease,  and  that  the  State  does  not  judiciously  recog- 
nize inebriety  as  a  disease. 

Science  further  claims  that  no  man  has  a  right  to  become 
a  drunkard,  because,  as  a  rule,  every  man  has  a  choice  in 
the  matter,  and  he  ought  to  choose  what  is  best  for  the 
individual  and  for  society. 

Science  further  claims  that  "  Punishment  is  no  cure  for 
the  Disease  of  Inebriety." 

The  State  and  science,  therefore,  differ  in  their  ideas 
about  "becoming"  and  "being  "a  drunkard.  The  State 
considers  "becoming  a  drunkard"  a  personal  riglit,  and 
"  being  a  drunkard  "  a  crime.  Science  holds  "  becoming  a 
drunkard  "  to  be  a  sin,  and  "being  a  drunkard  "  a  disease. 

Second.     Is  drunkenness  a  disease? 

The  laws  of  the  State  sanction  moderate  and  temperate 
drinking.  The  men  who  made  the  laws  did  it  in  accord 
with  the  wish  of  the  public.  And  the  public,  no  doubt,  is 
satisfied  tliat  the  State  cannot  legislate  its  people  into  tem- 
perate habits.  The  people  must  be  educated  to  be  temper- 
ate through  the  press,  the  pulpit,  the  school,  and  the 
lecture. 


DUTY    OF   THE    STATE.  241 

There  are  men  who  are  said  to  get  drunk  by  accident. 
These  are  indiscreet  and  sliould  not  be  judged  harslily. 
They  ouglit  to  beware  of  accidents  lest  they  become  habitual 
drunkards. 

Tlie  habitual  drunkard,  however,  suffers  from  a  disease 
called  dipsomania. 

Habitual  drunkenness  or  dipsomania  maybe  inherited  or 
it  may  be  acquired. 

"Dipsomania  is  a  mental  alienation  due  to  a  morbid  con- 
dition of  the  nervous  structures,  generally  hereditary.  The 
strictly  periodical  form  of  this  type  of  dipsomania,  the  ten- 
dency to  gradually  shorten  the  intervals  as  the  years  pass, 
and  the  peculiar  mental  condition  preceding  the  debauch, 
are  a  proof  that  dipsomania  is  a  disease  of  the  cerebral  ner- 
vous centers  analogous  to  recurring  neurosis,  such  as  epi- 
lepsy, etc. 

This  disease  is  nothing  but  an  attack  of  uncontrollable 
drunkenness,  always  kept  up  until  the  stomach  refuses 
longer  to  tolerate  the  alcoholic  drinks.  Then  the  attack 
stops  as  suddenly  as  it  came,  the  sufferer  recovers  his  usual 
health  and  spirits  and  enters  into  his  business  in  a  way  as 
if  nothing  had  happened.  As  a  general  thing  these  attacks 
recur  at  intervals  of  from  one  to  six  months,  and  the  end  is, 
some  disease  of  the  renal,  hepatic,  or  gastric  organ  carries 
off  the  patient. 

Earnest  resolutions  or  pledges  do  no  good  to  ward  off 
the  attack.  When  the  time  comes  the  patient  succumbs. 
An  indescribable  feeling  of  weakness  of  the  nervous  system 
is  generally  the  first  sign  of  an  attack.  This  may  be  brought 
on  by  over-work,  over-study,  anxiety,  worry,  trouble,  anger, 
etc.,  and  the  patient  thinking  himself  proof  against  a 
debauch  by  his  long  interval  of  sobriety,  yields  to  the  temp- 
tation, and  then  nothing  can  head  him  off.  Friends, 
family,  duty,  rank,  morality,  resolution,  and  pledge  are  all 
forgotten,  and  the  patient  will  drink  as  long  as  his  stomach 
will  bear  it.     So  strong  is  this  desire  for  drink,  while  the 


242  DISEASES   OF   INEBRIETY. 

attacks  last,  that  the  patient  will  drink  as  long  as  he  has 
money,  or  rather  as  long  as  he  can  get  the  liquor,  though 
he  may  have  to  beg,  borrow,  or  steal  it. 

Such  people  are  the  despair  of  their  friends,  the  tor- 
ment or  ruin  of  their  families,  the  scandal  of  their  com- 
munity. Seventy  times  seven  they  fall  and  are  lovingly 
raised  up.  They  express  contrition,  they  make  firm  prom- 
ises of  amendment,  but  they  always  fall. 

From  the  researches  of  many  authors  it  appears  that 
inebriety  is  a  nervous  disease  closely  allied  to  insanity, 
which  manifests  itself  either  periodically  or  constantly.  It 
may  commence  suddenly  as  a  consequence  of  some  severe 
shock  to  the  brain.  The  disease  may  also  have  its  origin 
in  the  social  habits  of  the  patient,  who  from  a  simple  con- 
vivial drunkard  may  become  transformed  into  a  regular 
inebriate.  It  may  be  produced  by  the  action  of  other 
poisons  besides  alcohol,  so  that  there  may  be  as  many 
varieties  of  inebriety  as  of  narcotics.  There  must,  how- 
ever, be  a  predisposition  to  inebriety  in  order  to  effect  its 
evolution.  Healthy  men  without  neurotic  predispositions 
may  drink  voluntarily  in  moderation  without  thus  breaking 
down  ;  but  an  inter-current  disease  may  turn  the  tide  even 
against  such  individuals,  and  if  they  do  not  themselves 
suffer  the  penalty  of  indulgence,  their  children  will  be  found 
far  on  the  road  that  leads  to  inebriety.  Hereditary  influ- 
ences are  among  the  most  potent  that  determine  this  dis- 
ease and  they  follow  the  usual  course.  Thus,  in  mixed 
families,  the  male  children  of  an  inebriate  mother,  or  the 
female  children  of  an  inebriate  father,  may  alone  exhibit 
the  morbid  tendency. 

There  is  another  type  of  drunkenness  which  goes  under 
the  name  of  ebriosity,  and  by  which  is  understood  the  con- 
dition of  continual  half-way  intoxication.  This,  necessarily, 
occurs  only  among  saloon-keepers  and  those  engaged  in  the 
liquor  traffic,  having  access  at  all  times  to  alcholic  drinks. 
This  is  a  very  fatal  form  of  drunkenness,  and  may  be  called 


DTTTT   OF   THE    STATE.  243 

incurable.  It  is  the  form  of  drinking  which  life  insurance 
companies  especially  fear. 

Habitual  drunkenness  is,  therefore,  a  disease  brought 
on  by  the  excessive  use  of  alcoholic  drinks,  though  this  use 
may  or  may  not  have  been  continual,  and  the  victim  is  an 
involuntary  slave  of  an  insane  propensity.  He  knows  what 
is  right,  but  cannot  choose  it  ;  and  he  knows  what  is  wrong, 
but  cannot  shun  it.  There  is  no  loss  of  the  power  to  judge 
of  right  and  wrong  nor  any  disturbance  as  to  facts,  but  the 
mind  is  powerless  to  control  conduct  according  to  knowl- 
edge. This  state  which  the  drunkard  is  in  may  be  called 
criminal  irresponsibility. 

Third.  Can  the  drunkard  cure  himself  or  be  cured  under 
the  existing  circumstances  ? 

In  the  early  stages  of  dipsomania,  inherited  or  acquired, 
something  can  be  done  for  the  patient,  but  the  cures  are 
the  exception. 

As  to  chronic  cases  of  drunkenness  a  reformation  is 
improbable  and  very  nearly  impossible  under  the  existing 
circumstances.  The  temptations  are  too  great  and  the 
opportunities  are  too  many,  and  though  the  drunkard  may 
have  a  desire  to  reform  or  to  cure  himself,  his  will-power  is 
enfeebled  and  he  cannot  resist  the  demands  of  his  habits 
unless  he  be  removed  from  temptation  and  it  be  made 
absolutely  impossible  for  him  to  get  a  drink.  The  drunk- 
ard is  an  object  of  contempt  and  disgust  as  a  drunkard,  and 
an  object  of  pity  and  danger  as  a  man,  as  a  father,  as  a  son, 
and  as  a  brother.  He  is  pitied  by  all  good  men,  but  they 
are  powerless  to  help  him.     He  cannot  help  himself. 

He  cannot  reform  while  he  is  in  the  midst  of  tempta- 
tion. The  licensed  liquor  houses  are  easy  of  access,  and 
indiscreet  friends  are  not  wanting  to  tempt  him  to  go  into 
such  places  and  to  take  but  one  drink,  which  is  the  spark 
that  lights  the  attack. 

Dr.  Kerr  says,  "  The  struggle  of  the  intemperate  for  free- 


244  DISEASES   OF   INEBRIETY. 

dom  is  a  combat  more  terrible  tlian  any  other  figlit  on 
earth."     It  is  a  hopeless  figlit,  I  add,  if  unassisted. 

Dr.  Parrish  sa3^s,  "The  temptation  with  which  they  are 
tempted  is  within.  It  is  subjective.  It  circles  in  the  stream 
that  gives  them  life.  It  may  be  likened  to  a  battery  that  is 
hidden  somewhere  in  the  cerebral  substance — connected  by 
continuous  fiery  wires,  with  a  coil  in  every  ganglion,  from 
whence  they  continue  to  extend — attenuating  and  distribu- 
ting as  they  go,  reaching  after  the  minutest  nerve  fibrils, 
which  need  only  a  throb  from  the  inborn  impulse  to  trans- 
mit a  force  that  quivers  in  every  muscle  and  burns  in  every 
nerve  till  the  victim  is  suddenly  driven  to  debauchery." 

Tell  me  now,  is  not  the  condition  of  the  drunkard  a 
deplorable  one  ?  In  fact,  is  it  not  a  blot  on  civilization  ? 
Should  not  something  be  done  to  prevent  the  increase  of 
drunkenness  and  to  diminish  what  there  is  of  it.-* 

Fourth.  If  the  drunkard  cannot  cure  himself,  has  he  a 
right  to  be  protected  against  himself  and  against  those  who 
are  licensed  by  the  State  to  sell  him  the  wherewithal  to 
remain  a  drunkard  ? 

It  is  true  that  there  are  a  great  many  private  institutions 
throughout  the  country  for  the  cure  of  inebriates,  and  they 
do  a  great  deal  of  good,  but  the  charges  for  treatment  in 
these  institutions  cannot  be  met  by  the  majority  of  drunk- 
ards. Taking  into  consideration  that  less  than  a  year's 
treatment  will  do  no  good,  it  is  quite  plain  that  the  majority 
of  these  unfortunates  have,  under  tlie  circumstances,  no 
chance  whatever  offered  to  them  to  become  cured  of  their 
malady.  This  is  a  serious  matter  to  those  afiflicted  with  the 
drinking  habit,  and  it  is  in  their  behalf  that  I  make  this 
appeal  to  the  citizens  of  Indiana,  relying  on  their  feelings 
of  justice,  charity,  mercy,  and  humanity  that  my  efforts  in 
behalf  of  the  habitual  drunkard  will  not  be  without  success, 
I  ask  for  these  unfortunates  nothing  but  what  is  just. 
There  is  no  hope  for  these  poor  creatures  until  they  are 
withdrawn  from  temptation  and  placed  under  restraint. 


DUTY    OF   THE    STATE.  245 

Fifth.  After  a  man  becomes  a  drunkard  is  he  a  danger- 
ous man  to  society  ?  and,  if  so,  has  society  a  right  to  be 
protected  against  the  drunkard  ? 

The  State  protects  society  against  the  drunkard  in  the 
following  manner  : 

1.  The  law  assumes  that  he  who,  while  sane,  puts 
himself  voluntarily  into  a  condition  in  which  he  knows  he 
cannot  control  his  actions,  must  take  the  consequence  of 
his  acts,  and  that  his  intentions  may  be  inferred. 

2.  That  he  who  tlius  voluntarily  places  himself  in  such 
a  position,  and  is  sufficiently  sane  to  conceive  the  perpetra- 
tion of  the  crime,  must  be  assumed  to  have  contemplated 
its  perpetration. 

3.  That  as  malice  in  most  cases  must  be  shown  or 
established  to  complete  the  evidence  of  crime,  it  may  be 
inferred  from  the  nature  of  the  act,  how  done,  the  provoca- 
tion or  its  absence,  and  all  the  circumstances  of  the  case. 

4.  The  law  has  not  yet  judicially  recognized  inebriety 
as  a  disease. 

The  State  does  in  every  way  trj'  to  prevent  the  making 
of  robbers,  thieves,  burghirs,  and  murderers,  and  criminals 
in  general,  but  it  licenses  men  to  make  the  drunkard.  The 
State  protects  society  against  the  murderer  and  the  robber 
by  imprisoning  him,  but  it  allows  the  drunkard  to  con- 
stantly menace  the  well-being  of  society. 

Would  you  say  that  the  poor  wife,  who  supports  herself 
and  her  children  by  sewing  and  washing,  has  no  right  to  be 
protected  against  the  evil  habits  of  her  husband  ?  Would 
you  siy  that  tlie  drunkard's  children  have  no  right  to  be 
protected  against  the  evil  influence,  the  bad  example,  and 
the  burden  of  drunkenness  of  their  father,  which  threatens 
to  blight  their  whole  lives  ?  Would  you  say  tliat  the  friends 
of  the  drunkard  have  no  right  to  have  an  asylum  provided, 
wherein  they  may  place  their  unfortunate  son  or  brother  or 
sister  or  father  or  mother  or  friend,  in  order  that  they  may 


246  DISEASES    OF    INEBRIETY. 

be  cured  of  their  malad3%  which  is  a  curse  to  ail  coming  in 
daily  contact  with  tiie  habitual  drunkard  ? 

These  are  questions  that  can  have  but  one  answer.  Yes  ; 
society  should  be  protected  against  the  drunkard,  who  is 
made  by  consent  of  the  State  in  accord  with  public  opinion. 

Sixth.  If  society  has  a  riglit  to  be  protected  against  the 
drunkard,  if  the  drunkard  has  a  right  to  be  protected  against 
himself,  and  if  the  drunkard  has  a  riglit  to  be  protected 
against  those  who  are  licensed  by  the  State  to  sell  him  the 
wherewithal  to  remain  a  drunkard,  does  it  not  follow  that 
the  State  should  afford  the  protection  ? 

In  answer  to  this  question  I  read  you  several  extracts  : 
"  From  the  very  nature  of  the  malady  it  is  scarcely  to  be 
expected  that  the  inveterate  drunkard  will  voluntarily  sub- 
mit to  control,  or  continue  under  it  for  a  sufficient  length  of 
time  to  receive  lasting  benefit ;  and  therefore  it  seems 
essential,  as  in  the  case  of  other  insanities,  that  legal  power, 
with,  indeed,  the  neglect  of  law^  to  provide  such  a  check  and 
remedy,  seems  inconsistent,  unjust,  and  inhumane  when  we 
consider  that  while  it  permits  the  insensate  drunkard  to 
endanger  his  life,  to  waste  his  property,  and  deprive  liis 
family  of  that  which  they  are  justly  entitled  to  expect  from 
his  hands  during  life,  or  to  fall  to  them  at  his  death,  it  holds 
him  responsible  for  any  criminal  act  he  may  commit.  No 
doubt  the  law  assumes  that  he  drinks  voluntarily,  and  with 
his  eyes  open  to  all  the  consequences,  and  that  his  practices 
therefore  form  an  aggravation  of  his  guilt  ;  but  such  is  not 
the  case,  for  he  drinks  involuntarily,  and  he  is  unable  to 
exercise  his  reason  aright  or  govern  his  will." 

"  All  experience  has  shown  that  little  progress  or  none 
can  be  made  toward  the  permanent  recovery  of  a  dipso- 
maniac so  long  as  his  business  places  him  in  more  or  less 
contact  with  alcoholic  drinks,  or  in  frequent  association 
with  drinking  comrades.  Consequently,  both  physician 
and  friends  should  combine  their  influence  to  separate  as 
far  as  possible  the  patient  from  such  associations.     And  if 


DUTY   OF   THE    STATE.  247 

it  cannot  be  done  in  any  other  way,  let  him  be  induced  to 
take  a  residence  for  six  or  twelve  months  in  a  well-regu- 
lated asylum  for  inebriates  until  the  paroxysmal  tendencies 
have  been  broken.  Enforced  seclusion  in  a  proper  asylum, 
with  no  possibility  of  obtaining  any  kind  of  alcoholic  drink, 
but  where  good  air,  good  food,  kind  treatment,  and  some 
suitable  employment  can  be  furnished,  on  the  same  prin- 
ciple that  applies  to  the  treatment  of  insane  persons,  will 
save  them  from  early  destruction." 

"For  the  permament  cure  of  inebriety,  however,  nothing 
avails  but  special  treatment  in  hospitals  provided  for  this 
class  of  patients.  Of  these  the  number  is  increasing  as  the 
public  becomes  informed  regarding  the  nature  of  the  dis- 
ease and  the  appropriate  means  of  combating  its  ravages." 

Dr.  Carpenter  says  :  "  However  responsible  he  may  have 
been  for  bringing  the  disease  on  himself,  his  responsibility 
ceases  as  soon  as  he  comes  under  the  influence  of  the  malady. 
The  disease,  however,  may  not  be  brought  on  by  the  act  of 
the  individual,  and  then  it  is  clear  at  once  that  neither 
directly  nor  indirectly  can  he  be  deemed  responsible.  But, 
suppose  that  it  were  the  result  of  his  previous  conduct,  I 
repeat  that,  however  culpable  he  may  have  been  for  that,  he 
is  not  a  responsible  being  while  afflicted  with  the  malady  ; 
for  I  can  see  no  distinction  between  this  form  of  the  disease 
and  any  other  which  has  been  induced  by  the  habits  or  acts 
of  the  individual. 

"  The  only  chance  of  a  cure  or  alleviation  is  from  atten- 
tion to  the  health  and  abstinence  from  intoxicating  liquors. 
Neither  can  he  be  cured  so  long  as  the  patient  is  at  large, 
and  no  amendment  can  be  depended  on,  unless  he  has 
undergone  a  long  course  of  discipline  and  probation.  Con- 
sidering, then,  that  the  individual  is  irresponsible  and 
dangerous  to  himself  and  others,  and  that  his  disease  can 
be  treated  only  in  an  asylum,  it  is  not  only  merciful  to  him 
and  to  liis  relatives,  but  necessary  for  the  security  of  the 
public,  that  he  be  deprived  of  the  liberty  which  he  abuses 


248  DISEASES    OF   INEBRIETY. 

and  perverts,  and  that  he  should  be  prevented  from  com- 
mitting crimes  instead  of  being  punished — or,  I  should 
rather  say,  being  the  object  of  vindictive  infliction — after 
he  has  perpetrated  them. 

"  Of  the  chronic  form  I  have  seen  only  one  case  com- 
pletely cured,  and  that  after  a  seclusion  of  two  years'  dura- 
tion. In  general,  it  is  not  cured.  Paradoxical  though  the 
statement  may  appear  to  be,  such  individuals  are  sane  only 
when  confined  in  an  asylum." 

The  insane  asylums  cannot  and  ouglit  not  to  be  used  as 
a  home  for  inebriates.  Only  those  in  the  last  stages  of  alco- 
holism, that  is,  only  those  who  are  actually  insane,  are  sent 
there.  Special  attention  cannot  be  paid  to  cases  of  inebriety 
in  the  insane  asylums  ;  besides,  no  one  would  voluntarily 
apply  for  admission  into  an  insane  asylum,  and  if  he  were 
to  do  so,  it  were  questionable  whether  he  would  be  admitted. 
Therefore,  the  insane  asylums  offer  no  aid  to  the  inebriate. 

Seventh.  If  the  State  should  afford  the  drunkard  a  chance 
to  be  cured  of  his  malady,  how  can  it  be  done  ? 

The  only  way  in  which  the  State,  under  the  existing  cir- 
cumstances, can  provide  a  protection  for  the  drunkard,  so 
that  he  may  be  cured  of  his  malady,  is  by  erecting  and 
maintaining  homes  for  inebriates.  The  sending  of  confirmed 
drunkards  to  these  homes  should  be  made  compulsory  by 
laws  in  the  same  manner  as  the  insane  are  sent  to  the  asylums. 
Voluntary  entering  into  the  homes  by  confirmed  drunkards 
should  be  encouraged,  but  only  allowed  after  a  proper 
examination  by  two  physicians,  who  should  certify  as  to 
the  condition  of  tlie  patient.  A  complete  history  of  the 
case  would  also  help  the  medical  superintendent  and  his 
medical  assistants  in  treating  the  patient. 

The  inebriate  must  remain  at  the  home  at  least  a  year, 
when  the  medical  superintendent,  under  the  advisement  of 
the  board  of  trustees,  may  let  the  patient  out  on  trial  until  he 
has  proven  himself  able  to  govern  his  will.  The  friends 
should  not  be  allowed  any  control  over  the  patient  after  he 


DUTY    OF   THE    STATE.  249 

becomes  an  inmate  of  the  home  to  which,  according  to  cir- 
cumstances, lie  is  assigned. 

It  is  not  my  object  to  direct  just  how  these  homes  should 
be  built  and  afterwards  carried  on  ;  all  this  is  subject  to 
the  decision  of  those  who  make  the  laws  ;  but  I  feel  that 
in  order  to  make  this  paper  of  sufificient  worth  to  merit 
attention,  I  must  give  a  general  outline  of  what  can  be  done 
for  the  inebriate.  With  this  object  in  view,  I  will  suggest 
that  the  money  derived  from  the  licenses  issued  and  from 
the  fines  collected  from  those  who  are  not  yet  confirmed 
drunkards,  and  from  those  who  transgress  the  law  by  selling 
to  minors,  by  selling  on  Sundays,  by  selling  without  a 
license,  etc.,  be  used  for  erecting  a  home  for  inebriates  of 
the  male  sex,  and  another  for  the  female  sex,  and  for  the 
sustainment  of  these  homes. 

The  homes,  after  they  were  once  in  good  working  order, 
could  be  made  self-sustaining  under  efficient  management. 
Indeed,  the  inmates  should  be  employed  in  labor,  in  order 
to  learn  discipline  and  improve  their  bodily  health.  They 
should  also  be  afforded  recreation  and  amusement  to  pre- 
vent discontentment  with  the  situation  in  which  the}'  are 
placed,  and  to  convince  them  that  there  are  other  ways  of 
enjoying  life  besides  sitting  in  a  saloon  and  becoming 
drunk. 

These  homes  should  be  erected  in  the  country,  away 
from  temptation.  Proper  rules  and  regulations  should  gov- 
ern the  inmates  as  well  as  those  in  attendance.  The  super- 
intendents should  be  medical  men,  who  ouglit  to  be  under 
the  control  and  advisement  of  a  board  of  directors  or  trus- 
tees, one  of  whom  should  be  the  President  of  the  State 
Board  of  Health.  The  salaries  of  the  officers  should  be 
regulated  by  law,  and  they  ouglit  to  give  a  bond.  Politics 
would  necessarily  have  something  to  do  with  tlie  appointing 
of  these  men,  which,  undoubtedly,  would  be  for  the  best. 

The  drunkard  who  is  out  on  trial  should  be  considered 
as  belonging  to  the  institution  until  he  has  kept  sober  for 


250 


DISEASES   OF   INEBRIETY. 


the  time  of  one  year.  Should  he  show  signs  of  return  of 
his  malady  before  the  year  is  up,  he  should  immediately  be 
brought  back  to  the  home.  It  is  presumed  that  the  person 
who  can  keep  sober  one  year  is  no  longer  to  be  considered 
an  habitual  drunkard. 


CHAPTER   XXV. 

CARE  AND    CONTROL  OF   PAUPER   INEBRIATES    IN   TOWNS 
AND  CITIES. 

A  certain  proportion  of  the  population  of  towns  and  cities 
are  composed  of  what  are  called  the  "  Criminal  Classes  " — 
those  that  require  the  constant  espionage  of  the  police,  and 
the  adjudication  of  justice.  Intermingled  with  these  in  no 
small  proportion  is  tlie  pauper  inebriate — friendless,  home- 
less,— appearing  in  varions  roles  on  the  public  stage  as 
drunkard,  tramp,  or  vagrant,  many  times  entered  on  the  blot- 
ter of  the  police  station  as  an  "  habitual  drunkard,"  or 
"rounder," — appearing  at  the  various  hospitals  and  dispen- 
saries with  disease  or  injury  incident  to  his  habits — finally  we 
find  him  in  the  wards  of  the  charity  hospital  or  among  the 
chronic  insane  of  the  insane  asylum,  if  perchance  sudden 
death  from  natural  causes  or  suicide  has  not  intervened — 
and  whether  his  career  terminates  on  the  street  or  in  the 
hospital,  or  the  cell  or  asylum,  the  trench  in  "  Potter's 
Field  "  receives  him,  and  thus  the  story  ends. 

During  the  year  1887  the  department  of  police  and 
excise  of  the  city  of  Brooklyn  report  23,912  arrests  ;  of 
these  arrests  13,862  were  for  intoxication  ;  of  these,  108  are 
stated  as  habitual — we  presume  this  to  mean  that  they  were 
known  to  the  police  as  "habitual  "drunkards,  but  it  will  at 
once  be  seen  that  this  is  entirely  out  of  proportion  to  the 
number  arrested.  It  would  be  no  risk  to  say  that  of  the 
13,754  intoxicated  persons  arrested,  many,  if  not  the  larger 
proportion,  were  habitual  or  periodical  users  of  alcoholic 
stimulants,  and  that  to  intoxication. 

251 


252  DISEASES   OF   INEBRIETY. 

The  English  testimony  as  to  the  relation  which  alcohol 
bears  to  the  so-called  criminal  classes  is  very  conclusive. 
In  the  "testimony  of  chief  constables  and  superintendents 
of  police,"  taken  before  "  The  Committee  on  Intemperance 
for  the  Convocation  of  York,"  in  1874,  in  reply  to  this  ques- 
tion— "  What  proportion  of  those  who  have  come  under 
your  cognizance  as  criminals  have  been  the  victims  of 
drinking  habits  and  associates." 

A.  "  If  by  the  term  criminal  is  meant  persons  convicted 
of  any  offence  against  the  law,  sixty-five  or  seventy  per 
cent." 

B.  "  Nearly  all." 

C.  "  Fully  nine-tenths." 

D.  "  Quite  nine-tenths." 

E.  "Twenty  per  cent,  of  the  summary  convictions  of 
one  year  are  absolutely  for  drunkenness — exclusive  of  a 
large  proportion  of  the  residue  attributable  to  drunkenness." 

F.  "  Nearly  half  the  entries," 

G.  "About  three-fourths." 

H.  "  During  the  past  twelve  months  in  this  division  there 
has  been  283  persons  apprehended  for  serious  offences.  I 
can  safely  state  that  200  apprehensions  were  directly  caused 
from  the  effects  of  drink." 

Question — "  What  proportion  of  those  taken  into  custody 
are  under  influence  of  liquor  ?" 

A.  "  25  per  cent,  in  country,  70  per  cent,  in  town." 

B.  "Those  directly  arrested  and  those  summoned,  all 
cases,  90  per  cent." 

C.  "  70  out  of  every  100  persons  when  arrested  are  drunk." 

D.  "  161  persons  arrested  in  this  district  in  one  year,  75 
were  under  influence  of  liquor." 

E.  "50  per  cent,  are  apprehended  as  drunks  and  disor- 
derly independent  of  any  other  offence." 

F.  "  The  majority  of  persons  arrested  and  charged  with 
drunkenness.     I  should  say  70  out  of  every  100." 

We  then  have  the  testimony  of  chief  constables,  superin- 


CAEE    AND   CONTROL   IN   TOWNS    AND    CITIES.  253 

tendents  of  police,  governors  of  goals,  and  chaplains,  that  at 
least  two-thirds  if  not  three-fourths  of  all  arrests  made  by 
the  police,  the  persons  were  addicted  to  the  use  of  alcohol, 
and  that  a  large  proportion  of  these  were  intoxicated  when 
arrested. 

If  we  were  to  consult  the  police  and  criminal  records  of 
any  of  our  large  cities,  New  York,  Philadelphia,  or  Boston, 
we  might  not  equal  but  we  should  certainly  approximate 
such  testimony  as  that  given  before  the  "  Convocation  at 
York,"  We  cannot  then  shut  our  eyes  to  the  fact  that  in 
every  city  and  town  a  certain  proportion  of  the  population 
are  more  or  less  continually  under  the  influence  of  alcohol, 
and  that  to  a  degree  often  dangerous  to  the  community  at 
large.  Intoxication,  with  or  without  overt  criminal  acts, 
continually  occurs,  rendering  it  necessary  to  arrest  and 
imprison  this  class. 

The  question  now  before  us  is  whether  the  present 
method  of  dealing  with  the  inebriate  is  the  best,  and  if  not, 
what  are  its  disadvantages.  Those  who  have  given  thought 
to  the  subject  confidently  assert,  that  the  present  method 
of  arrests,  fines,  and  short  term  imprisonment  (or  occasional 
six  months)  is  not  the  proper  and  scientific  way  of  dealing 
with  the  inebriate.  By  this  method,  on  regaining  his 
liberty  the  individual  simply  repeats  his  act  of  intoxication 
and  is  again  subject  to  arrest,  fine,  or  imprisonment  ;  after 
this  has  been  repeated  several  times,  he  is  known  as  the 
"  repeater,"  or  "  rounder."  Instances  are  on  record  where 
one  person  was  subjected  to  arrest  for  intoxication  over  one 
hundred  times,  a  period,  of  course,  extending  over  some 
years, 

A  female  is  reported  as  having  been  convicted  forty- 
eigiit  times  for  various  offences,  at  all  times  committed 
through  drink.  She  paid  ^200,  or  $1,000,  as  fines  for  drunk- 
enness. The  large  majority  in  English  prisons  of  re-com- 
mittals are  due  to  intemperance.  If  crime  be  associated 
with    the  intoxication,   as  assault,  grand  larceny,  tlien  the 


254  DISEASES   OF   INEBRIETY. 

clironic  inebriate,  strange  to  assert,  will  get  the  best  treat- 
ment ;  tlie  law  will  give  him  the  full  benefit  of  his  criminal 
act.  Restraint,  and  a  long  continued  period  of  total  abstin- 
ence will  be  enforced  during  his  term  of  imprisonment, 
and  when  his  sentence  expires,  he  will  often  leave  greatly 
benefited,  and  practically  a  sober  man.  Instances  aie  on 
record  where  the  inebriate  has  requested  that  he  might  be 
placed  in  prison  and  thus  secure  restraint,  seclusion,  and 
the  discipline  of  prison-life,  and  thus  attain  habits  of  sobri- 
ety. 

The  testimony  from  English  prisons  is  singularly  unan- 
imous on  this  point  as  well  as  conclusive. 

Question — "  Do  you  consider  the  health  of  patients  would 
be  affected  by  total  abstinence  from  intoxicating  drink  ?" 
Governors  of  jails  testified  "  prisoners  are  universally  bene- 
fitted ;  there  are  cases  where  it  might  be  occasionally  used, 
as  in  feeble  and  broken-down  prisoners — but  these  occasions 
were  rare."  As  a  rule,  men  who  have  served  long  periods 
of  imprisonment,  and  who  have  been  habitual  drinkers,  go 
out  heavier  and  better  in  health  than  they  came  in.  Their 
general  improvement  in  health  is  due  to  cleanly  habits, 
warm  bath,  good  ventilation,  regular  rest,  systematic  exer- 
cise, connected  with  prison  discipline,  and  total  abstinence 
from  liquor  of  all  kinds. 

This  result  incidently  points  out  clearly,  we  think,  the 
general  plan  and  method  by  which  we  ought  to  control  and 
treat  the  pauper  inebriate.  He  ought  to  have  all  the 
advantages  that  prison  discipline  may  secure  to  him  with- 
out the  necessity  of  a  criminal  proceeding  on  his  part. 

Undoubtedly,  the  law,  in  dealing  with  the  inebriate, 
simply  as  an  inebriate,  is  faulty  or  only  partial  in  its  effect 
upon  him.  "It  practically  does  this,  it  arrests  him,  and 
fines  or  imprisons  him  for  a  short  period — too  short  for  any 
benefit  to  be  derived  from  it," — and  then  lets  him  go.  The 
law  is  like  an  incompetent  physician  :  it  first  makes  a  wrong 
diagnosis,  and  then  prescribes  an  inert   and  therefore  inef- 


CAKE   AND   CONTROL   IN   TOWNS    AND   CITIES.  255 

fectual  remedy.  It  reprimands  the  inebriate,  it  does  not 
treat  his  case  at  all.  It  looks  upon  the  inebriate  as  an  indi- 
vidual who  has  the  knowledge  of  right  and  wrong,  and  full 
power  of  volition  ;  it  regards  the  act  of  inebriation  as 
deliberate  and  voluntary,  and  therefore  it  proceeds  by  fines 
and  imprisonment  to  lash  back  into  moral  decency  and 
rectitude  the  offender. 

But  do  we  not  recognize  the  value  of  restraint  ?  Would 
we  permit  the  brawling  drunkard  to  make  night  hideous,  or 
the  insane  drunkard  to  scatter  ruin  right  and  left  ?  Cer- 
tainly not. 

What  plan  would  then  have  all  the  advantages  of  the 
present  system  of  dealing  with  the  inebriate,  and  none  of  its 
disadvantages  ? 

In  the  first  place,  as  to  arrest  and  restrahtt.  The  inebri- 
ate should  be  arrested  if  found  intoxicated  upon  the 
street  or  any  public  place,  or  upon  a  warrant  issued  on  due 
complaint  of  his  family,  or  in  case  they  failed  to  do  their 
duty,  by  a  committee  of  reputable  citizens  of  the  ward  in 
which  the  inebriate  was  a  resident,  or  the  officers  of  said 
ward.  A  warrant  should  be  issued  on  complaint  from  any  of 
said  parties,  by  the  proper  justice,  and  the  inebriate  arrested. 

Proper  testimony  sliould  then  be  secured  as  to  facts 
concerning  his  inebriety  from  reputable  medical  and  other 
sources.  He  should  then  be  sent  to  an  inebriate  reformatory, 
hospital,  or  work-house,  for  the  institution  should  include  all 
these  features  ;  we  are  dealing  with  a  diseased  person,  not 
a  criminal,  but  as  a  pauper  inebriate,  without  friends,  or  if 
he  has  friends,  without  means. 

There  are  abundant  provisions  for  the  wealthy  inebriate. 
Private  asylums  are  numerous,  and  the  appointments  are 
very  complete  for  his  treatment  both  here  and  abroad.  It 
is  the  pauper,  his  more  unfortunate  brother,  whom  we  are 
considering. 

The  pauper  inebriate  is  now  duly  arrested  ;  he  must  be 
restrained   and   controlled   for  some   definite   time  in  some 


256  DISEASES   OF    INEBRIETY. 

institution.  The  period  should  be  not  less  than  one  year, 
made  longer  if  necessary  by  recommittal.  The  institution 
to  which  he  is  committed  should  be  placed  in  the  suburbs 
of  the  city  or  town,  with  convenient  access  to  it.  Abundant 
grounds  should  surround  the  building,  or,  better  still,  a 
farm  should  be  the  site  of  its  location.  Out-door  occupa- 
tion, so  beneficial  in  the  treatment  of  the  chronic  insane, 
would  be  no  less  so  in  the  case  of  the  inebriate.  A  compe- 
tent medical  superintendent,  with  suitable  assistants,  could 
readily  conduct  such  an  institution.  Its  inmates  would  be 
chronic  inebriates  ;  all  insane  persons,  or  those  incurable 
from  other  diseases,  should  be  sent  to  their  proper  asylums 
or  hospitals.  Such  an  institution,  with  properly  appointed 
work-shops,  a  farm  under  cultivation,  well-stocked  and 
planted,  with  a  practical  farmer  at  the  head  to  regulate  the 
labor  of  the  inmates,  would  be  almost  self-sustaining,  for 
the  inmates  would  not  be  like  those  in  an  insane  asylum, 
mentally  inefificient,  or  those  in  a  charity  hospital,  physi- 
cally helpless,  but  many  would  be  skilled  workmen  who 
outside  would  command  good  wages.  Then,  also,  a  system 
of  payment  for  extra  work  might  be  made,  so  that  when 
they  left  the  reformatory  something  would  be  due  them, 
and  they  would  not  be  turned  out  paupers.  If  this  plan 
were  adopted,  a  large  body  of  chronic  inebriates  that  now 
drift  about  in  the  community  would  not  only  be  restrained 
but  made  to  a  certain  extent  self-supporting,  and  in  a  cer- 
tain proportion  of  cases  cured. 

The  inebriate  Home  at  Fort  Hamilton  is  based  on  some 
such  plan,  and  demonstrates  on  a  moderate  scale  what 
might  be  accomplished  on  a  larger  one. 

Every  large  town  and  city  should  have  such  an  institu- 
tion of  sufficient  size  to  meet  its  wants,  containing  a  farm, 
a  work-house,  and  suitable  medical  care.  It  should  be 
readily  accessible,  although  the  price  of  land  would  regulate 
somewhat  the  site  of  its  location. 

The  locality  should  be  healthy,  and  the  internal  and  sur- 


CARE   AND   CONTROL   IN   TOWNS    AND   CITIES.  257 

rounding  sanitary  conditions  good.  The  dietary  should  be 
generous,  of  good  quality,  and  the  food  well-cooked.  This 
is  essential.  Specialists  in  lunacy  have  found  that  a  certain 
way  to  precipitate  acute  or  sub-acute  lunacy  into  the  ciironic 
forms  is  to  put  the  patient  on  low  and  innuiritious  diet. 
Out-door  exercise  and  occupation,  as  well  as  those  measures 
that  will  eventually  appeal  to  his  better  nature,  lead  him 
back  to  thoughts  of  home  and  family,  develop  his  higher 
tendencies,  prompt  his  aspirations,  and  raise  him  above  the 
mere  animal  life  he  has  led  so  long.  To  deprive  such  a  one 
of  religious  privileges,  or  the  intellectual  enjoyment  he  may 
crave,  is  a  refined  species  of  cruelty  that  no  true  form  of 
philanthropy  would  be  guilty  of  or  tolerate. 

This  is  no  sentiment,  it  is  practical  fact  and  truth,  for 
among  these  pauper  inebriates  are  found  lawyers,  editors, 
physicians,  clergymen,  writers,  artists,  and  skilled  artizans, 
men  who  have  fallen  from  high  estate.  It  is  natural,  then, 
with  returning  and  improved  physical  and  moral  perception 
they  should  begin  to  crave  that  which  feeds  the  intellect 
and  administers  to  the  improved  moral  tone. 

So  much,  then,  for  the  Reformatory,  the  work-house,  the 
hospital,  where  we  would  place  the  chronic  inebriate  with- 
out friends  and  without  means. 

But  while  the  above  institution  will  care  for  the  chronic 
inebriate,  it  does  not,  and  cannot,  fill  a  want  severely  felt  and 
long  needed — how  shall  we  deal  with  intoxicated  persons 
arrested  on  the  streets  by  the  police? 

The  usual  metiiod  is  to  arrest  them,  take  them  to  the 
nearest  police  station,  prefer  a  charge  of  intoxication,  with  or 
without  disorderly  conduct,  record  the  case  on  the  blotter, 
and  commit  the  accused  to  a  cell,  to  await  the  sentence  of 
the  justice.  The  following  morning  he  is  brought  before 
the  police  court — if  a  first  offence,  and  not  paiticularly  ag- 
gravating, sentence  may  be  suspended — usually  a  fine  is  in- 
flicted— and  if  this  cannot  be  paid,  ten  days  in  jail  is  the 
penalty.     If  the  prisoner  is  an  "  old  offender"  and  *'  incorri- 


258  DISEASES    OF     INEBRIETY. 

gible  who  has  appeared  before  the  justice  probably  several 
times,  lie  or  she  is  sent  to  the  "penitentiary"  or  the  "  Island  " 
for  a  period  not  exceeding  six  months.  To  this  method  of 
dealing  with  intoxicated  persons  arrested  on  the  street  or 
other  public  place  there  are  several  objections  ;  in  the  first 
place,  the  average  policeman  is  not  a  good  diagnostician. 
Every  case  where  the  person  is  found  stupid,  dazed,  or  un- 
conscious, is  to  him  a  "  drunk,"  and  must  be  "  run  in." 
Hence,  persons  suffering  from  stupor,  partial  or  complete, 
arising  from  certain  cerebral  conditions  resultant  from  head 
injury,  uraemic  disease,  or  narcotics  of  any  kind,  unless  these 
conditions  are  accompanied  by  marked  evidence  of  assault, 
or  other  severe  injuries,  are  apt  to  be  mistaken  for  alcoholic 
intoxication.  This  is  not  the  fault  of  the  police — they  are 
not  diagnosticians,  neither,  indeed,  can  be — these  cases 
oftentimes  puzzle  the  experienced  physician.  The  system 
that  allows  such  a  state  of  affairs  to  exist  is  at  fault,  not  the 
policeman  who  fails  to  make  a  proper  diagnosis. 

Certainly,  to  place  such  cases  in  a  cell,  and  allow  hours 
to  elapse  before  the  true  condition  of  affairs  is  apprehended, 
is  a  grave  and  serious  error. 

But  even  if  the  stupor  is  alcoholic,  and  the  ar»-est  there- 
fore legitimate,  we  maintain  that  the  cell  is  an  unfit  place 
for  such  a  person  seriously  intoxicated. 

Richardson,  in  his  "  Cantor  Lectures,"  thus  writes  : 
"  Whenever  we  see  a  person  disposed  to  meet  the  effects  of 
cold  by  strong  drink  it  is  our  duty  to  check  that  effort,  and 
whenever  we  see  an  unfortunate  person  under  the  influence 
of  alcohol,  it  is  our  duty  to  suggest  warmth  as  the  best 
means  for  his  recovery. 

"  These  facts  prompt  many  other  useful  ideas  of  detail  in 
our  common  life.  If,  for  instance,  our  police  were  taught 
the  simple  art  of  taking  the  animal  temperature  of  persons 
they  have  removed  from  the  streets  in  a  state  of  insensi- 
bility, the  results  would  be  most  beneficial.  The  operation 
is  one  that  hundreds  of    nurses  now  carry  out   daily,  and 


CARE   AND   CONTROL   IN   TOWNS    AND    CITIES.  259 

applied  to  our  police-officers  at  their  stations,  it  would 
enable  them  not  only  to  suspect  the  difference  between  a 
man  in  an  apoplectic  fit  and  a  man  intoxicated,  but  would 
suggest  naturally  the  instant  abolition  of  the  practice  of 
thrusting  the  really  intoxicated  into  a  cold  and  damp  cell, 
which  to  sucli  a  one  is  actually  an  ante-room  to  the  grave." 

In  view  of  this,  in  the  "  London  Metropolitan  District  " 
the  cells  in  whicli  intoxicated  persons  are  received  are 
properly  warmed  in  cool  weather. 

In  addition  to  this  we  maintain  that  every  case  of  alco- 
holic coma  or  stupor  should  come  under  medical  supervis- 
ion, that  the  police  surgeon  should  make  the  diagnosis, — 
not  the  policeman  who  made  the  arrest — and  appoint  the 
proper  remedial  agencies.  Too  often  the  cell  door  has 
been  shut  and  the  prisoner  allowed  to  "  sleep  off "  his 
intoxication,  and  "the  sleep  that  knows  no  waking"  has 
come  to  him  before  morning. 

It  has  been  suggested  that  in  every  large  city  there  be 
established  a  central  hospital,  convenient  of  access,  where  all 
seriously  intoxicated  persons,  or  persons  found  dazed  or 
stupid  upon  the  streets  from  other  causes,  can  be  taken  and 
receive  prompt  medical  aid,  and  from  thence,  after  they  are 
sufficiently  recovered,  sent  to  their  own  homes,  or  if  friend- 
less and  homeless,  assigned  to  the  insane  asylum,  the  ine- 
briate asylum,  the  charity  hospital,  or  such  institution  as 
seems  to  be  most  appropriate  for  their  condition. 

There  is  still  another  class,  not  directly  coming  under 
police  supervision,  to  whom  such  central  reception  hospital 
would  be  a  great  boon — those  who  through  alcoholic  ex- 
cesses develop  delirium  tremens  or  acute  alcoholic  delirium, 
those  living  in  boarding-houses  whose  means  are  limited, 
who  cannot  command  nursing  and  medical  attention.  The 
regular  city  hospitals  refuse  such  cases,  except  special 
arrangements  are  made  and  high  rates  are  charged  ;  then 
only  cases  of  acute  alcoholism  are  taken — of  course,  chronic 
alcoholics  are  peremptorily  refused.     There  is  good  reason 


260  DISEASES    OF   INEBRIETY. 

for  this;  general  hospitals  have  no  special  provision  for 
cases  of  contagious  disease,  insane  persons,  or  cases  of 
alcoholism  ;  no  padded  rooms,  no  extra  attendance,  none 
of  the  appointments  necessary  for  the  care  of  such  cases. 

The  suburban  inebriate  hospital  outside  of  the  city  is 
already  tested  to  its  full  capacity  with  chronic  cases  of 
inebriety.  It  is  at  some  distance  from  the  city,  and  to  enter 
a  patient  in  its  wards  requires  certain  legal  formalities,  and 
therefore,  time. 

Such  a  central  hospital  in  the  city,  accessible  at  all 
times,  especially  to  this  class  of  cases  under  consideration, 
for  which  no  provision  is  made  at  the  general  hospitals, 
would  provide  at  least  temporar}'  care  and  treatment  for 
insane  or  intoxicated  persons  found  upon  the  street.  It 
would  be  a  channel  through  whicli  the  inebriate  asylum, 
the  insane  asylum,  or  the  general  hospital,  would  receive  its 
proper  class  and  quota  of  patients.  It  would,  as  a  "  bureau 
of  distribution,"  save  much  trouble  now  experienced  in 
assigning  insane  persons  to  inebriate  asylums,  and  alcoholic 
to  insane  asylums,  as  well  as  persons  to  either  of  these  who 
might  need  the  care  of  a  general  hospital. 

While  not  directly  established  for  this  work,  it  would  in- 
directly do  considerable  of  it. 

Besides  this,  the  establishment  of  sucii  a  special  hospi- 
tal mainlv  for  the  treatment  of  such  cases,  would  afford 
excellent  opportunities  to  study  alcoholism  in  its  more 
acute  forms.  The  capacity  of  such  a  hospital  need  not 
exceed  fifty  beds,  as  from  it  would  be  constantly  sent  out 
all  cases  not  appropriate  to  it,  and  all  cases  assuming  a 
chronic  character. 

It  would  not  be  altogether  dependent  on  the  city  for  its 
support,  as  the  friends  of  many  would  gladly  pay  for  the 
privilege  of  having  cases  treated  in  its  wards  ratiier  than  in 
their  own  homes.  Acute  cases  of  alcoholism,  after  recovery 
from    the  immediate  attack,  should  their  cases    warrant   it, 


CARE   AND   CONTROL   IN   TOWNS    AND    CITIES.  261 

could  be  assigned  or  committed  to  the  inebriate  asylum  for 
*'  chronic  inebriates." 

Fortunately,  we  are  not  without  precedent  in  this  matter. 
The  establishment  of  a  special  city  hospital  devoted  to  the 
care  of  "acute  cases  of  alcoholic  delirium,"  to  which  the 
police  are  directed  at  all  times  to  bring  persons  found  upon 
the  streets  seriously  intoxicated  or  stupid  from  other  cause, 
and  all  others  who  may  desire  to  have  their  friends  treated 
for  acute  alcoholism.  "  The  Bureau  d'Admission,"  of  the 
department  of  the  Seine,  at  St.  Anne  Asylum  in  Paris,  of 
whicli  Dr.  Magnan  is  one  of  the  two  physicians,  is  an  insti- 
tution to  which  no  exact  parallel  exists  in  England  or  in  this 
country.  To  it  are  brought  all  the  cases  of  insanity  pre- 
vious to  their  admission  to  the  various  public  asylums,  and 
all  cases  of  acute  delirium  or  mania  whicii  fall  under  the 
care  of  the  police  in  Paris.  It  is  here  that  they  are  exam- 
ined, and  their  admission  or  rejection  decided  upon.  If 
admitted,  they  are  drafted  to  the  one  or  other  of  the  asylums 
which  is  most  suited  to  the  class  of  the  patient,  or  the  form 
of  his  malady. 

The  Bureau  d'Admission  is  quite  distinct  from  the  St. 
Anne  Asylum  itself,  and  under  altogether  different  admin- 
istration. In  order  to  provide  accommodation  for  the  tempo- 
rary lodgment  of  patients  on  their  way  to  other  asylums, 
and  also  for  the  reception  of  the  more  acute  cases,  it  is  pro- 
vided with  about  fifty  beds,  and  is  fitted  up  in  every  way  as 
a  small  asylum.  Here  there  are  brought  all  the  cases  of 
delirium  tremens  and  "simple  alcoholic  delirium  "  which 
fall  under  the  notice  of  the  police,  and  a  large  number  from 
the  lower  and  middle  classes,  and  here  they  are  treated 
until  tiieir  recovery.  Hence,  it  comes  to  pass  that  a  very 
large  proportion  of  all  the  cases  of  delirium  tremens  occur- 
ring in  Paris  and  its  vicinity  come  under  observation  here, 
and  this  not  only  in  one  attack,  but  again  and  again,  and 
when  at  last  by  repeated  attacks  they  have  become  mentally 


262  DISEASES   OF   INEBRIETY. 

deranged  or  greatly  weakened,  they  again  come  under 
notice  for  transference  to  asylums. 

The  results  of  such  opportunities  of  observation  could 
scarcely  fail  to  be  productive  of  an  increase  of  our  knowl- 
edge, and  their  value  is  necessarily  augmented  by  the  fact 
of  their  being  utilized  by  experienced  alienists,  and  seen 
side  by  side  with  other  forms  of  acute  delirium.  In  addi- 
tion to  the  hospital  wards  there  is  an  out-door  department, 
where  discliarged  patients  and  others  return  for  treatment 
of  the  various  nervous  disorders   induced  by  their  habits. 

This  hospital  does  excellent  work,  but  there  should  be  a 
large  suburban  hospital  for  the  control  of  the  more  chronic 
forms  of  inebriety,  and  persons  treated  for  an  acute  attack 
"should  not  be  allowed  to  return  again  and  again,  until 
their  minds  were  weakened  and  they  became  thus  fit  sub- 
jects for  the  insane  asylum." 

Such  asylums,  for  long  periods  of  commitment  of  chronic 
inebriates,  exist  in  America,  in  England,  in  Australia,  in 
New  Zealand,  and  in  Germany. 

Much  interest  is  now  manifested  by  the  public  and  the 
legislatures  of  States  on  this  all-important  topic.  It  is  nec- 
essary, therefore,  that  legislative  effort  be  directed  in  the 
proper  channels,  and  the  inebriate,  who  constitutes  so  large 
a  proportion  of  our  population,  should  be  laid  hold  of  and 
dealt  with  systematically  and  scientifically — not  as  criminals, 
but  as  those  deprived  of  their  reason  and  their  volition — 
those  automatic  in  their  actions,  vicious  in  their  propensities 
— a  curse  to  the  community  in  which  they  dwell.  Restrain, 
control  this  class,  and  you  reduce  prodigality,  want,  disease, 
to  a  minimum,  and  produce  the  best  sort  of  political  economy, 
based  on  science  and  common  sense.  Allow  this  class  their 
liberty,  and  you  foster  these  evils,  and  encourage  and  prop- 
agate their  results. 

Imprisonment,  punishment — all  punitive  laws — have 
failed  to  abate  or  even  mitigate  the  evil.  Any  effort 
directly    based    on   fear  of   punishment   or    moral  persua- 


CAKE    AND   CONTROL   IN   TOWNS   AND   CITIES.  263 

sion  will  fail.  We  must  place  the  evil  on  its  true  basis, 
— that  of  DISEASE, — and  treat  it  accordingly.  Yellow 
fever,  cholera,  small-pox  we  quarantine.  We  investigate 
the  causes  of  epidemics,  and  we  endeavor  to  remove  that 
cause  ;  so  with  alcohol  and  its  attendant  evils.  Punitive 
and  restrictive  laws  should  be  directed  against  the  manu- 
facture and  sale  of  alcohol,  not  against  its  victim,  the 
inebriate.  How  we  shall  care  for  the  homeless,  friendless, 
pauper  inebriate,  as  he  is  presented  to  us  in  the  acute  and 
chronic  forms  of  his  malady,  it  has  been  the  province  of 
this  paper  to  point  out. 


CHAPTER  XXVI. 

SAME   MEDICO-LEGAL   CONSIDERATIONS. 

It  has  become  a  maxim  in  law  that  drunkenness  is  no 
excuse  for  crime.  The  interpretations  of  phenomena  by 
theology  and  medicine  are  undergoing  modifications  in  con- 
sonance with  the  advancement  in  science  and  discovery, 
which  distinguishes  the  age  in  which  we  live.  Similar  in- 
terpretations- by  the  law,  however,  are  not  so  impressible. 
The  movements  of  the  law  are  necessarily  cautious  and  de- 
liberate. The  legal  principle  which  denies  to  drunkenness 
any  liberty  with  respect  to  crime,  must  have  its  reason  in 
some  presumed  expediency,  in  the  absence  of  exact  knowl- 
edge. For  the  true  principles  which  underlie  the  several 
and  distinct  varieties  in  motive  and  intent,  inciting  the 
inebriate  in  the  gratification  of  his  unnatural  appetite,  are 
even  now  undergoing  study  and  analysis.  The  law  has 
been  unable,  hitherto,  to  offer  a  comprehensive  and  satis- 
factory explanation  and  definition  of  drunkenness  ;  and  its 
dictum,  therefore,  that  inebriation  is  no  excuse  for  crime, 
must  be  open  to  suspicion. 

It  is  certain  that  a  man  indubitably  drunk  is  not  in  his 
right  mind,  and  that  he  can  not,  by  any  power  within  him- 
self, either  mental  or  physical,  conduct  himself  as  he  would 
do  when  not  intoxicated. 

It  is  also  certain  that  his  departures  from  the  lines  of 
right  reason  are  fundamental  and  not  frivolous.  But 
drunkenness  is  a  state  of  mind  and  body  usually  of  brief 
duration.  The  sober  mind  has  means  within  itself  of  study- 
ing the  nature  of  drunkenness  between   spells,  as   well  as 

265 


266  DISEASES   OF   INEBRIETY. 

observing  it  in  others.  It  is  capable  of  perceiving  that  the 
use  of  alcoholic  liquors  will  induce  a  condition  of  the  men- 
tal faculties  wherein  motives  and  intent?  are  unusual  and 
unsound,  as  well  as  beyond  volitional  control.  But  the 
questions  arise  :  Are  there  not  radical  differences  in  the 
motives  which  impel  to  drunkenness  ?  Is  not  intoxication, 
very  frequently  indeed,  the  result  of  the  demands  of  a  disease 
or  of  an  urgency  in  the  feelings  which  an  attending  imbe- 
cility of  mind  is  unable  to  control  or  overcome  ?  If  these 
interrogatories  really  fore-shadow  actual  facts,  then  it  must 
be  that  there  are  important  exceptions  to  the  proposition 
that  drunkenness  is  no  excuse  for  crime  ;  for  the  inebriate 
may  then  be  not  merely  irresponsible,  abstractly,  when 
drunk,  but  he  may  be  irresponsible  for  the  imbecility  of 
will  which  so  readily  yields  to  the  demands  of  the  neu- 
rotic constitution. 

In  the  neurotic  constitution  even  slight  intoxication  is 
often  succeeded  by  an  utter  blank  in  the  memory.  This 
withdrawal  of  the  mind  from  the  direct  line  and  knowl- 
edge of  conscious  life  implies  radical  disabilities  in  the 
assumption  of  responsibility  for  conduct.  Drobisch  ex- 
plained clearly  the  general  nature  of  the  law  of  association 
in  psychology  in  the  language  following  :  Psychology  shows 
that  not  only  memory  and  imagination,  but  judgment, 
reasoning,  conscience  itself,  and,  in  general,  all  higher 
activity  and  all  development  of  the  mind  rest  upon  the 
association  and  reproduction  of  states  of  consciousness  ; 
that  this  explains  also  the  different  variations  of  feeling, 
emotion,  desire,  passion,  and  rational  will.  But  these 
explications  are  supported  by  generalities  that  have  always 
an  indeterminate  character.  This  arises  from  their  lack  of 
quantitative  determination.  Whatever,  therefore,  is  con- 
ceded or  permitted  to  a  congenital  infirmity  of  mind  in  its 
relations  with  the  world  at  large,  must  also  be  accorded  to 
constitutional  incapacity  in  any  special  direction.  The 
well-defined  neurotic  or  spasmodic  drunkard  is  an  imbecile 


SOME    MEDICO-LEGAL    CONSIDEKATIONS.  267 

in  respect  to  his  desire  for  intoxication  ;  for,  in  the  con- 
genital inebriate,  the  association  and  reproduction  of  states 
of  consciousness  neitlier  are,  nor  can  they  become,  witli 
respect  to  his  special  besetment,  eitlier  normal  or  manage- 
able. 

In  general  terms  it  may  be  said  that  inebriety  is  origin- 
ally— that  is,  anterior  to  its  hereditary  descent  in  varying 
forms — the  outcome  of  very  serious  bodily  injury,  but  more 
especially  injury  to  the  head.  The  history  of  the  late  civil 
war  abounds  in  exemplifications  of  this  fact.  Certain  physi- 
cal wounds  affect  directly  portions  of  the  brain,  or  they  may 
withdraw  from  normal  correspondence  and  relationship  with 
the  brain  to  important  parts  of  the  body  elsewhere.  The 
means,  and  measure,  and  quality  of  consciousness,  through 
many  channels  of  sensation  and  association,  are  thus  perma- 
nantly  destroyed.  Thus  there  are  produced  radical  defects 
in  consciousness,  which  in  respect  to  inebriety  prevent  those 
conservative  mental  operations  and  associations  upon  which 
all  higher  activity  and  all  development  of  mind  rest.  I  have 
said  neurotic  inebriety  is  primarily  occasioned  by  some 
physical  injury,  possibly  in  remote  ancestry.  This  includes, 
of  course,  such  injuries  to  nervous  integrity  as  may  arise 
from  any  adequate  cause,  perhaps  not  technically,  yet  in 
reality  physical,  as  prolonged  grief,  great  nervous  shock, 
excessive  study,  protracted  and  profound  disease,  malaria, 
and  many  other  recognized  sources  of  that  peculiar  state  of 
nervous  instability  and  inadequacy  which  goes  under  the 
general  designation  of  the  neurotic  constitution.  Absence 
of  function  begets  incapacity  to  act  through  sheer  debility 
of  nerve,  or  even  through  atrophy  of  substance. 

Dr.  Livingston,  after  years  of  absence  amongst  the  black 
tribes  of  Africa,  says  that  upon  coming  into  the  presence  of 
his  countrymen  he  was  at  home  in  everything  except  his 
own  mother  tongue.  He  seemed  to  know  the  language 
perfectly  ;  but  the  words  he  wanted  would  not  come  at  his 
call.     It  is  difficult  to  divest  the  mind  of   the  idea  that  the 


268  DISEASES   OF  INEBRIETY. 

inebriate  is  really  capable  of  mastering  his  morbid  proclivity 
at  will.  And  that  there  may  be — in  view  of  the  lack  of 
quantitative  determination  in  the  character  of  the  nervous 
disability  in  the  neurotic  inebriate — certain  instances 
wherein  the  defect  is  not  overmastering,  seems  probable. 
Yet  this  very  qualification  may  doubtless  include  innumer- 
able instances  in  which  voluntary  restraint  is  impossible.  No 
man  by  taking  thought  can  add  one  cubit  unto  his  stature. 
Neither  can  a  man  by  any  process  of  reasoning,  or  any 
effort  of  will,  change  the  functions  appertaining  to  physical 
defect  or  pathological  deterioration  into  the  ways  of  normal 
and  physiological  life. 

It  is  impossible  to  discuss  the  exact  time  when  the  brain 
becomes  diseased  by  alcohol  and  its  victim  loses  self-con- 
trol, or  what  quantity  of  that  stimulant  a  person  can  use 
before  becoming  a  dipsomaniac.  This  point  of  time  can  be 
no  more  satisfactorily  arrived  at  than  the  true  time  required 
for  the  production  of  yellow  fever  by  the  application  of  its 
exciting  cause.  Some  constitutions  would  be  affected  in 
five  minutes.  In  others  it  would  require  weeks  or  perhaps 
months  of  exposure  to  miasmata  before  the  individual 
would  discover  the  premonitory  S3'mptoms  of  the  disease. 
So  it  is  with  different  individuals  who  are  in  constant  use 
of  alcoholic  stimulants. 

It  is  impossible  for  the  physician  to  state  when  the  con- 
stitution is  first  affected  by  disease.  The  dividing  line 
between  health  and  disease  has  never  been  determined. 
Nor  can  it  ever  be  defined.  The  physiologist  has  never 
been  able  to  draw  the  dividing  line  between  sanity  and 
insanity,  or  to  determine  how  much  of  the  exciting  cause  it 
requires  to  produce  a  morbid  condition  of  the  brain. 

These  nice  distinctions  in  regard  to  the  pathology  of  dis- 
ease do  not  enter  into  the  discussion  in  reference  to  the  im- 
portance of  asylums  for  the  control  and  medical  treatment 
of  dipsomaniacs. 

Neither  can   we   point   out  the  dividing  line    where  the 


SOME    MEDICO-LEGAL    CONSIDERATIONS.  269 

moral  responsibility  ceases,  and   the  irresponsibility   begins 
in  the  use  of  alcoholic  stimulants. 

The  time,  when  an  institution  can  reach  the  dipsomaniac 
is  when  he  has  lost  self-control,  and  the  law  regards  him  as 
a  dangerous  citizen,  or  when  he  can  be  induced  to  enter 
the  asylum  voluntarily. 

We  contend  that  when  the  brain  is  diseased  from  defect- 
ive nutrition,  by  any  animal  or  vegetable  poison,  by  any 
great  shock  on  the  nervous  system  impairing  the  nervous 
fluids  of  the  body,  there  will  be  a  corresponding  disease  of 
mind,  which  disease  will  develop  all  tlie  peculiar  types, 
stages,  and  phases  of  insanity,  from  the  most  inoffensive  to 
the  most  furious  and  dangerous.  It  matters  not  how  this 
disease  may  have  been  induced,  wliether  by  stimulants  pre- 
scribed in  sickness,  or  by  the  influence  of  social  friends  ; 
whether  under  extenuating  circumstances,  or  in  full  view  of 
the  terrible  penalty  which  this  malady  inflicts  on  its  victim  ; 
the  State  is  equally  bound  to  protect  society  against  the  in- 
sane acts  of  this  dipsomaniac.  He  should  be  committed  to 
an  asylum  for  restraint  and  treatment  adapted  to  his 
physical  and  mental  condition. 

All  the  laws  and  penalties  which  a  State  can  enact 
against  crime  committed  by  the  dipsomaniac  will  never 
prevent  him,  while  at  large,  from  committing  murder,  arson, 
or  theft,  or  from  taking  his  own  life.  Why,  then,  should 
our  State  allow  its  citizens  to  go  at  large,  when  they  have 
lost  self-control,  and  when  daily  experience  shows  that  it  is 
not  compatible  with  private  and  public  safety  for  them  to 
remain  at  liberty  ? 

Does  the  State  bring  to  life  the  murdered  family  by 
simply  going  through  the  accustomed  forms  of  judicial 
procedure,  in  order  to  punish  the  man  for  what  he  cannot 
be  responsible,  or  place  him  as  a  criminal  at  the  bar,  when 
his  testimony  would  not  be  received  in  the  witness  box,  or 
find  out,  too  late,  that  he  really  is  a  maniac,  and  send  him 
at  last  to  an  asylum  as  a  criminal  lunatic. 


270  DISEASES   OF   INEBEIETT. 

The  only  true  and  enlightened  policy  for  the  State  is  to 
provide  asylums  for  tliis  class  of  insane. 

What  IS  it  ?  is  the  question  of  the  hour.  To  find  the 
answer,  let  it  first  be  determined  what  or  who  are  inebriates. 
That  there  are  thousands  of  persons  who  consume  intoxi- 
cants habitually  and  constantly,  who  are  never  visibly 
intoxicated,  is  a  very  obvious  truth.  It  is  nevertheless  true, 
that  there  are  many  who,  by  nature  and  constitutional  bias, 
are  inebriates,  who  have  never  taken  an  inebriating  draught, 
but  who,  knowing  theijiselves,  and  their  morbid  tendency, 
avoid  the  danger  of  excess  by  absolute  and  perpetual  abstin- 
ence. 

Not  a  few  such  persons  may  be  found  among  intelligent 
and  careful  people,  with  whom  each  day  is  a  day  of  conflict 
— of  conflict  with  themselves  and  their  environment.  Tliey 
are  a  multitude  of  heroes,  whose  battles  with  self  will  never 
be  known,  and  the  record  of  whose  conquests  will  never  be 
made.  Such  cases  have  their  analogues  in  various  forms  of 
morbid  inheritance,  only  two  of  which  need  now  be  men- 
tioned, insanity  and  pulmonary  consumption. 

The  natural  history  of  insanity  and  inebriety  is  so  simi- 
liar  that  it  is  sometimes  difficult  to  draw  the  line  cf  separa- 
tion. Indeed,  they  are  so  near  to  each  other  as  to  admit 
in  some  cases  of  an  equal  place  in  nosology,  as,  for  example, 
in  the  use  of  the  terms  '*  insane  drunkenness  "  and  "drunken 
insanity,"  both  representing  kindred  pathological  conditions. 
The  relationship  is  so  patent  even  to  the  unprofessional 
observer,  that  I  need  dwell  no  longeron  this  point  than  to 
allude  to  a  striking  inconsistency  in  the  law,  as  viewed  from 
a  medical  standpoint.  If  I  understand  its  meaning,  the  law 
discriminates  between  common  drunkenness  and  dipso- 
mania, but  fails  to  recognize  the  likeness  between  dipso- 
mania and  insanity,  or,  in  other  words,  it  does  not  see  a 
similarity  between  insanity  from  drink  and  insanity  from 
other  causes,  though  the  manifestations  may  be  similar.  It 
assumes    that    the    dipsomaniac    is   a  voluntary   demon   or 


SOME    MEDICO-LEGAL    CONSIDERATIONS.  271 

drunkard,  and  if  he  will,  he  may  avoid  the  paroxysms  that 
characterize  the  disease. 

Science,  however,  declares  a  dipsomaniac,  or  an  inebriate 
in  the  medical  sense,  to  be  what  he  is  from  an  impaired  or 
defective  will,  that  is  unable  to  resist  the  "  nerve  storm" 
which  assails  him  at  intervals,  that  he  cannot  always  antici- 
pate, as  is  the  case  in  hysteria,  epilepsy,  etc.  In  consequence 
of  this  error,  the  law  provides  in  the  same  statute  for  habit- 
ual drunkenness  and  insanity,  making  a  criminal  act  com- 
mitted by  an  insane  person  so  far  different  irr  its  results 
from  the  same  act  committed  by  an  inebriate,  as  to  warrant 
the  commitment  of  the  former  to  an  asylnm,  while  the  pen- 
alty inflicted  upon  the  latter  may  be  imprisonment  for  life 
in  a  penitentary,  or  it  may  be  hanging  by  the  neck  till  he  is 
dead. 

The  analogy  presented  by  pulmonary  consumption  may 
not,  in  the  view  of  some,  be  so  decided,  and  hence  I  invite 
attention  to  the  early  symptomatology  and  hereditary  signs 
of  tiie  two  disorders.  Thousands  are  being  born  with  a 
decided  and  well-marked  consumptive  diathesis,  but  who, 
knowing  tliemselves  and  their  family  history,  adapt  them- 
selves to  such  hygienic  and  climatic  methods  of  living  as 
tend  to  counteract  the  progress  of  the  disease,  and  thus 
avoid  its  fatal  ravages.  Such  persons,  however,  are  con- 
sumptives by  natural  descent,  who  would  go  steadily  on  to 
a  consumptive's  lingering  death,  but  for  the  knowledge  of 
their  tendency  to  it,  and  their  ability  to  avail  themselves  of 
means  to  resist  its  approaches.  While  it  is  interesting  to 
observe  these  analogues,  and  while  the  very  fact  of  likeness 
serves  as  confirmatory  evidence  of  disease,  there  is  ample 
testimony  from  distinguished  sources  to  fix  the  fact  of  dis- 
ease independent  of  any  likeness  to  other  morbid  condi- 
tions. Dr.  Quain  defines  disease  to  be  "  any  deviation 
from  the  standard  of  health,  in  any  of  the  functions  or  com- 
ponent materials  of  the  body." 

Dr.  Norman  Kerr  says  in  his  recent  work  on   inebriety, 


272  DISEASES   OF   INEBRIETY. 

"In  drunkenness  of  all  degrees,  and  every  variety,  the 
Churcli  sees  only  sin  ;  the  world,  only  vice  j  the  State,  only 
crime.  On  the  other  hand,  whatever  else  any  intelligent 
medical  practitioner  beholds  in  such  cases,  he  generally  dis- 
covers a  condition  of  disease,"  In  our  own  country,  the 
current  medical  opinion  favors  the  same  view,  and  I  am 
convinced  that  it  is  gaining  a  firmer  hold  on  the  public  mind 
in  all  departments  of  our  social  and  civil  life.  It  remains 
for  the  legal  and  the  judicial  sentiment  of  the  land  so  to 
classify  alcoholic  intoxication  as  to  remove  it  from  the  do- 
main of  morals,  not  even  regarding  it  as  a  species  of  moral 
mania,  but  to  accord  to  it  its  legitimate  place  as  a  physical 
disease. 

For  our  present  purpose,  at  least,  it  is  assumed  that  we 
are  agreed  as  to  the  abstract  question  of  disease  as  applied 
to  inebriety,  but  it  becomes  us  to  extend  our  inquiries  a 
little  further,  that  we  may  ascertain  to  what  class  of  disor- 
ders it  belongs.  By  common  consent  it  is  assigned  to  the 
realm  of  neurotic  disorders.  It  affects  most  immediately 
and  seriously  the  nervous  system.  Here,  again,  we  may 
pause  a  moment  to  notice  a  fact  concerning  the  complicated 
nervous  system,  which  I  think  is  not  fully  appreciated  out- 
side the  medical  profession.  I  refer  to  the  sympathetic 
system  of  nerves  as  distinct  and  largely  independent  of  the 
motor  system.  In  order  to  apprehend  the  ravages  of  alco- 
hol upon  the  sensitive  nature  of  man,  it  is  essential  that  we 
understand  the  functions  of  the  vital,  as  distinct  from  the 
mechanical  or  automatic  forces  and  movements  of  the  body. 
I  take  it  to  be  an  admitted  principle  of  law  that  to  consti- 
tute a  criminal  act,  the  will  must  consent  to  the  perform- 
ance of  the  act,  and  in  the  study  in  which  we  are  now 
engaged  it  is  highly  important  that  we  discriminate  as  I 
have  suggested  ;  that  we  appreciate  the  difference  between 
the  nervous  system,  which  has  to  do  with  vital  forces  and 
functions,  and  the  other  nervous  system,  which  does  not 
control  or  influence  vital  forces  or  functions. 


SOME    MEDICO-LEGAL    CONSIDERATIONS.  273 

The  inhibitory,  restraining  power  resides  in  the  series  of 
nerves  which  is  specifically  assailed  by  alcohol,  when  taken 
into  the  body,  and  this  is  the  prime  fact  in  the  whole  matter 
of  responsibility,  to  which  the  law  of  the  land  does  not  seem 
to  attach  importance.  I  read  in  my  Blackstone  that  "all 
the  several  pleas  and  excuses  which  protect  the  committer 
of  a  forbidden  act  from  the  punishment  which  is  otherwise 
annexed  thereto,  may  be  reduced  to  this  single  consideration 
— the  want  or  defect  of  will.  Indeed,  to  make  a  complete 
crime  cognizable  by  human  law,  there  must  be  both  a  will 
and  an  act."  In  the  time  when  this  wholesome  doctrine 
was  proclaimed,  the  dogma  of  disease,  as  applied  to  in- 
ebriety, was  not  considered.  Intoxication  was  taken  to 
be  a  voluntary  act,  and  hence  it  was  said  of  an  inebriate 
that  "  what  hurt  or  ill  soever  he  doeth,  his  drunkenness  doth 
aggravate  it." 

This  doctrine  may  be  to-day  orthodox  in  law,  but  in  med- 
icine it  is  not,  and  herein  lies  the  difference  between  law  and 
medicine.  Occasions  or  opportunities  like  the  present  are 
meant  to  reconcile  the  two  professions  to  the  acceptance  of 
this  wiser  doctrine  and  a  more  humane  practice. 

But  the  question  arises  here,  and  is  submitted  from  the 
legal  side.  If  inebriety  is  not  to  be  punished,  how  will 
society  be  protected  from  the  assaults  of  the  drunkard  ? 
Judge  Davis  says  :  "  No  disease  excuses  any  man  for  the 
commission  of  crime.  A  man  in  the  last  stages  of  consump- 
tion is  to  be  hanged  for  a  murder  as  surely  as  though  he 
was  in  perfect  health,  and  no  disease  by  reason  of  its  own 
existence  can,  under  any  circumstances,  excuse  any  man  for 
the  commirsion  of  crime.  Hence,  to  establish  that  it  is  a 
disease  is  only  to  put  it  on  the  exact  footing  on  which  all 
other  diseases  stand  in  respect  of  violation  of  law  and  their 
punishment."  If,  then,  insanity  being  considered  a  disease, 
and  inebriety  be  taken  by  law  to  be  also  a  disease  as  well 
defined  and  understood,  we  should  gain  all  that  we  ask  for. 
Then  I  sliould  hail  this  utterence  from  such  a  distinguished 


274  DISEASES    OP   INEBRIETY. 

source  as  the  keynote  of  a  new  doctrine,  which  should  be 
taken  up  by  the  courts  of  law  and  sounded  with  accumulat- 
ing force  and  rhythm  till  the  jurisprudence  of  the  whole 
range  of  disease  and  crime  in  their  joint  relation  shall  be 
infused  by  its  healthy  tone. 

While  it  proposes  that  society  shall  be  protected  from 
the  voluntary  and  deliberate  criminal  by  punishment,  be  it 
hanging  or  what  else,  it  will  protect  society  from  the  invol- 
untary and  unconscious  criminal  by  isolation  in  a  hospital 
or  asylum  provided  by  the  State  for  its  unfortunate  citizens 
who  have  come  into  this  world  with  an  organization  that  is 
out  of  harmony  with  the  ethical  and  civil  relations  which 
the  law  sanctions  and  provides  for.  When  the  philosophy 
of  law  and  the  science  of  medicine  shall  join  hands  together 
to  create  a  jurisprudence  founded  on  such  a  basis,  it  will  be 
a  step  toward  a  state  of  society  that  is  much  to  be  desired, 
and  will  be  doing  more  in  the  direction  of  relief  from  the 
blight  of  intoxication  than  can,  in  the  very  nature  of  things, 
be  done  by  the  methods  so  ineffectually  put  forth  at  this 
time. 

When  alcohol  enters  into  the  human  body  in  excess,  its 
affinity  for  nerve  structure  is  manifest  in  its  grasp  upon  the 
inhibitory  forces  as  among  its  very  early  influences.  The 
will  is  the  citadel  of  the  soul,  by  which  life  and  conduct  are 
guarded  and  guided,  but  when  it  is  seized  and  made  captive, 
to  obey  only  the  behests  of  this  destructive  force,  the  victim 
is  lost  to  himself,  and  acknowledges  that  he  is  enslaved. 
The  relation  of  the  human  will  to  the  nervous  system  is 
sadly  misjudged.  The  wonderful  network  of  nerves  known 
as  the  sympathetic  system  acts  independently  of  the  will. 
It  presides  over  vital  functions.  It  has  to  do  with  the  forces 
of  life  with  which  the  will  has  nothing  to  do.  The  heart 
beats,  the  stomach  digests,  all  the  vital  organs  fulfill  their 
respective  offices  without  any  reference  to  the  will.  It 
works  while  we  sleep,  and  the  vital  functions  are  performed 


SOME     MEDICO-LEGAL    CONSIDERATIONS.        .  275 

in  our  unconscious  rest.  By  its  side  the  will  is  powerless. 
If  it  presides  over  appetite,  its  behests  are  absolute. 

The  inebriate,  with  inherited  or  acquired  passion  for 
stimulants,  or  for  their  hypnotic  effect,  cannot  control  his 
longing  when  it  asserts  itself.  The  hungry  man  who  is 
starving  for  bread  cannot,  at  his  will,  bid  his  hunger 
depart.  The  true  inebriate,  when  his  restless  nerves  and 
sinking  spirits  and  burning  desire  demand  repose  and  satis- 
faction, must  obey  the  call.  He  obeys  though  his  will,  his 
conscience,  his  judgment,  his  past  experiences,  his  moral 
sense,  all  join  in  earnest  protest. 

Is  it  depravity  of  his  nature  or  infirmity  of  his  will  ?  A 
wide  distinction  exists  between  depravity  and  pravity  of 
will. 

Depravity  signifies  a  state  of  natural  debasement,  with- 
out any  cause.  The  idea  of  a  cause  is  precluded.  It  is 
natural. 

Pravity  signifies  a  departure  from  a  right  purpose,  for 
which  a  cause  is  implied  which  is  generally  subjective. 
Indeed,  an  impaired,  feeble  will  is  frequently  the  first  symp- 
tom of  an  approaching  debauch. 


CHAPTER  XXVII. 

MEDICO-LEGAL  QUESTIONS  (CONTINUED) — LAW  AND  RUL- 
INGS   OF    JUDGES. 

In  a  discussion  in  which  the  question  is  to  be  considered 
by  such  able  medical  men  from  the  medical  side  or  stand- 
point, it  has  seemed  to  me  that  it  would  be  of  interest  to 
both  professions,  as  well  as  to  laymen,  to  have  the  inquiry 
made  as  to  those  relations  which  attach  by  law  to  inebriety, 
as  well  in  the  civil  and  domestic  relations  of  the  inebriate, 
as  in  regard  to  crimes  committed  by  persons  while  acting 
under  the  influence  of  intoxicants,  or  while  in  a  state  of 
intoxication. 

What,  then,  is  the  present  legal  status  of  the  question  ? 

I  shall  briefly  state  (but  have  neither  opportunity  nor 
space  to  discuss)  wliat  I  believe  to  be  the  law  upon  the  sub- 
ject ;  citing  and  grouping  authorities — the  civil  side  first, 
and  the  question  of  criminal  responsibility  second. 

I.  Civil  Relations,  i.  Intoxication  was  regarded  by 
the  common  law,  when  complete  and  characterized  by  un- 
consciousness, as  a  species  of  insanity.  Lord  Coke's  fourth 
manner  of  "  7ion  compos  mentis  "  was  "  4.  By  his  own  act  as 
a  drunkard." 

Deliriutn  tremens,  which  results  directly  from  habits  of 
intoxication,  is  in  law  considered  to  be  a  form  of  insanity, 
and  this  has  been  repeatedly  held  by  the  courts. 

It  has  always  been  a  well-settled  rule  of  law  that  no  per- 
son can  make  a  contract  binding  upon  himself  while  he  is 
wholly  deprived  of  his  reason  by  intoxication.     This  would 

277 


278  DISEASES    OF    INEBRIETY. 

be  true  as  to  deeds,  wills,  all  instruments  and  obligations  of 
every  kind. 

This  rule  is  not  changed  where  the  intoxication  was  not 
procured  by  the  other  party  to  the  contract,  but  is  voluntary 
on  the  part  of  the  drunkard. 

By  tlie  common  law,  as  well  as  by  the  New  York  stat- 
ute, a  testator  must,  at  the  time  of  the  execution  of  a  will, 
bj  of  ^^  sou?id  niind  and  memory,"  and  it  is  as  requisite  to  have 
the  presence  of  a  '''disposing  memory,"  as  a  *'  sound  mind." 

{b)  By  common  law  and  by  statute  law  an  intoxicated 
person  is  thereby  rendered  incompetent  as  a  witness.  The 
statute  law  usually  classifies  sucli  intoxicated  persons  as 
lunatics,  and  the  provisions  frequently  apply  similarly  to 
each,  and'  to  both. 

(<:)  In  the  marriage  contract,  which  in  some  is  treated 
on  different  grounds  from  all  other  contracts,  from  the  neces- 
sity of  the  case  and  consequences  upon  consummation,  the 
sound  general  rule  has  been,  that  if  the  party  was  so  far 
intoxicated  as  not  to  understand  the  nature  and  consequences 
of  the  act,  this  would  invalidate  the  contract. 

2.  The  analogy  between  lunacy  and  total  intoxication, 
or  even  habitual  drunkenness,  is  doubtless  most  marked  in 
the  statutes  of  the  various  States,  regarding  the  care  and 
custody  of  the  person  and  estates  of  lunatics,  idiots,  and 
habitual  drunkards. 

(a)  By  English  law  the  Lord  Chancellor,  as  the  direct 
representative  of  the  Crown,  has  always  exercised  the  right 
of  assuming  the  custody  and  control  of  the  persons  and 
estates  or  all  those  who,  by  reason  of  imbecility  or  want  of 
understanding,  are  incapable  of  taking  care  of  themselves. 

Writs  de  lunatico  inquirendo  were  issued  in  cases  to  inquire 
whether  the  party  was  incapable  of  conducting  his  affairs 
on  account  of  habitual  drunkenness. 

The  Supreme  Court  of  every  American  State  would 
doubtless  have  the  right  which  the  Court  of  Chancery 
exercised  under  the  law  of  England  in  the  absence  of  any 


LAW    AND   KULINGS    OF   JUDGES.  279 

Statute  law.  This  must  be  so  in  the  nature  of  things  in 
American  States  ;  the  principle  has  been  exercised  and 
adjudicated  on  in  Kentucky,  in  Maryland,  Illinois,  Indiana, 
and  North  Carolina. 

The  Legislatures  of  the  various  States  have  vested  this 
power  by  statutory  enactments  in  various  tribunals,  for 
example  in  New  York,  by  the  old  law  in  the  chancellor  ;  in 
New  Jersey,  in  the  Orphans'  Court  ;  in  South  Carolina, 
equally  in  the  law  and  equity  side  of  the  courts,  and  now 
in  New  York,  where  the  distinction  between  law  and  equity 
has  been  abolished,  in  the  Supreme  Court,  which  exer- 
cises it. 

It  will  be  observed  that  in  many  of  the  American  States 
the  habitual  drunkard,  even,  is  classified  and  treated  under 
the  same  provisions,  and  in  the  same  manner  as  the  lunatic 
and  the  idiot,  notably  in  Pennsylvania,  New  Jersey,  Mary- 
land, Illinois,  New  York,  and  many  other  States. 

Taking  New  York  as  a  fair  illustration  of  the  principle, 
it  has  been  held  by  the  courts,  that  all  contracts  made  by 
habitual  drunkards  who  have  been  so  adjudged  in  proceed- 
ings de  lunatico  inquirendo  are  actually  void.  And  that  the 
disability  of  the  habitual  drunkard  continues  after  the 
committee  has  been  appointed,  even  when  he  is  perfectly 
sober  and  fully  aware  of  the  nature  and  consequences  of 
his  acts. 

It  has  also  been  held  that  habitual  drunkenness  being 
established,  it  x'?,  prima  facie  evidence  of  the  subject's  inca- 
pacity to  manage  his  affairs. 

We  may  then  assume,  in  considering  the  medical  juris- 
prudence of  inebriety,  that  the  law  has  always  regarded 
and  treated  intoxication  as  a  species  of  mental  derangement, 
and  has  considered  and  treated  the  habitual  or  other 
drunkard  as  entitled  to  the  special  care  and  protection  of 
Courts  of  Equity,  in  all  matters  relating  to  his  civil  rights, 
his  domestic   concerns,  his  ability  to    make   contracts,  his 


280  DISEASES   OF   INEBRIETY. 

intermarrying  and  disposing  of  his  property,  by  deed,  gift, 
or  devise. 

The  law  has  gone  farther,  for  it  has  thrown  round  him 
its  protecting  arm  and  shield,  when  it  is  satisfied  that  he 
has  become  so  addicted  to  drink  as  to  seriously  interfere 
with  the  care  of  his  estate,  and  the  courts  have  then  come 
in  and  taken  absolute  control  of  both  person  and  estate  of 
drunkards,  in  their  own  interest  and  for  their  presumed 
good. 

Medical  men  should  keep  in  mind  the  distinction  run- 
ning all  through  the  law  between  insanity  and  irresponsi- 
bility. The  medical  view,  that  irresponsibility  should  follow 
where  insanity  exists,  has  nowliere  been  conceded  by  the 
law,  and  this  distinction  must  be  borne  in  mind  in  the  sub- 
ject here  under  consideration. 

II.  Criminal  Relations.  This  brings  us  to  the  second 
question  :  The  relation  of  the  inebriate  to  the  criminal  law 
for  illegal  acts,  committed  while  intoxicated,  which  seems 
more  harsh  in  its  practical  effect  than  the  principles  which 
govern  him  in  his  civil  and  social  relations  to  society  and 
the  State. 

This  seeming  hardship,  however,  is  due  to  the  capacity 
of  the  drunkard,  considered  objectively,  for  wrong-doing. 
In  the  one  case  his  position  as  a  civil  agent  is  that  of  a  unit 
of  society  merely — one  who  is,  as  it  were,  to  be  "saved  from 
himself";  in  the  other  case,  the  criminal  aspect  of  the 
drunkard,  it  is  the  weal  of  society  which  is  to  be  conserved 
and  protected. 

I.  That  form  of  intoxication  which  results  in  the  total 
or  partial  suspension  of,  or  interference  with,  the  normal 
exercise  of  brain  function,  is  regarded,  at  law,  as  mental 
unsoundness,  and  sometimes  amounts  to  a  species  of  in- 
sanity. It  has  been  held  at  law  to  be  a  voluntary  madness, 
caused  by  the  willful  act  of  the  drunkard,  and  the  decisions 
have  been  uniform,  that  where  reason  has  been  thus  sus- 
pended, by  the  voluntary  intoxication  of  a  person  otlierwise 


LAW   AND   KULINGS   OF   JUDGES.  281 

sane,  this  condition  does  not  relieve  him  from  the  conse- 
quences of  his  criminal  acts,  or,  more  carefully  stating  it^ 
from  acts  committed  by  him  in  violation  of  law,  while  in 
that  state. 

(a)  There  are  decisions  which  go  to  the  length  of  hold- 
ing that  the  law  will  not  consider  the  degree  of  intoxica- 
tion, whether  partial,  excessive,  or  complete,  and  even  tiiat 
if  the  party  was  unconscious  at  the  time  the  act  was  com- 
mitted, such  condition  would  not  excuse  his  act  ;  and,  in 
some  cases,  judges  have  gone  so  far  as  to  instruct  juries 
that  intoxication  is  actually  an  aggravation  of  the  unlawful 
act  rather  than  an  excuse. 

But  the  better  rule  of  law  now  undoubtedly  is,  that  if 
the  person,  at  the  moment  of  the  commission  of  the  act,  was 
unconscious,  and  incapable  of  reflection  or  memory,  from 
intoxication,  he  could  not  be  convicted. 

There  must  be  motive  and  intention  to  constitute  crime, 
and  in  such  a  case  the  accused  would  be  incapable  from 
intoxication  of  acting  from  motive. 

[d)  The  reasons  upon  which  the  rule  of  law  rests,  may, 
with  great  propriety,  be  considered,  and  should  be  carefully 
studied,  before  any  attempt  at  criticism  is  made. 

1.  The  law  assumes  that  he  who,  wliile  sane,  puts  him- 
self voluntarily  into  a  condition,  in  which  he  knows  he 
cannot  control  his  actions,  must  take  the  consequences  of 
his  acts,  and  that  his  intentions  may  be  inferred, 

2.  That  he  who  thus  voluntarily  places  himself  in  such 
a  position,  and  is  sufficiently  sane  to  conceive  the  perpetra- 
tion of  the  crime,  must  be  assumed  to  have  contemplated 
its  perpetration, 

3.  That  as  malice  in  most  cases  must  be  shown  or 
established  to  complete  the  evidence  of  crime,  it  may  be 
inferred,  from  the  nature  of  the  act,  how  done,  the  provoca- 
tion or  its  absence,  and  all  the  circumstances  of  the  case. 

In  cases  where  the  law  recognizes  different  degrees  of  a 
given  crime,  and  provides  that  willful  and  deliberate  inten- 


282  DISEASES    OF   INEBRIETY. 

tion,  malice,  and  premeditation  must  be  actually  proved  to 
convict  in  the  first  degree,  it  is  a  proper  subject  of  inquiry 
whether  the  accused  was  in  a  condition  of  mind  to  be 
capable  of  premeditation. 

Sometimes  it  becomes  necessary  to  inquire  whether  the 
act  was  done  in  heat  of  passion,  or  after  mature  premedita- 
tion and  deliberation,  in  which  tlie  actual  condition  of  the 
accused  and  all  the  circumstances  attending  his  intoxica- 
tion, would  be  important  as  bearing  upon  the  question  of 
previous  intent  and  malice. 

(<r)  The  New  York  Penal  Code  lays  down  with  precision 
the  provision  of  law  governing  the  question  of  responsibility 
in  that  State  as  follows  : 

"§  22.  Intoxicated  persons. — No  act  committed  by  a  per- 
son, while  in  a  state  of  intoxication,  shall  be  deemed  less 
criminal  by  reason  of  his  having  been  in  such  condition. 
But  whenever  the  actual  existence,  of  any  particular  pur- 
pose, motive,  or  intent  is  a  necessary  element  to  constitute 
a  particular  species  or  degree  of  crime,  tiie  jury  may  take 
into  consideration  the  fact  that  the  accused  was  intoxicated 
at  the  time,  in  determining  the  purpose,  motive,  or  intent, 
with  which  he  committed  the  act." 

(^)  Voluntary  intoxication,  though  amounting  to  a 
frenzy,  has  been  held  not  to  be  a  defense  when  a  homicide 
was  committed  without  provocation. 

[e)  Delirium  tremens,  liowever, — a  condition  which  is  the 
result  of  drink  and  is  remotely  due  to  the  voluntary  act  of 
the  drunkard, — has  been  held  to  be  a  defense  to  acts  com- 
mitted while  in  the  frenzy,  similar  to  the  defense  of 
insanity. 

(/)  It  has  been  held  that,  when  inebriety  develops  into 
a  fixed  and  well-defined  mental  disease,  this  relieves  from 
responsibility  in  criminal  cases,  and  such  cases  will  be 
regarded  and  treated  as  cases  of  insanity. 

(^)  It   may  now  be   regarded  as  a  settled  rule  that   evi- 


LAW    AND   KULINGS    OF   JUDGES.  283 

dence  of  intoxication  is  always  admissible  to  explain  the 
conduct  and  intent  of  the  accused  in  cases  of  homicide. 

{h)  In  crimes  less  than  liomicide,  and  especially  wlieie 
the  intent  is  not  a  necessary  element  to  constitute  a  degree 
or  phase  of  the  crime,  this  rule  does  not  apply. 

The  practical  result,  however,  in  such  cases,  and  in  those 
States  where  the  latter  provision  of  tlie  New  York  Penal 
Code  has  not  been  adopted,  is  to  leave  this  whole  subject 
to  the  judges  who  fix  the  details  of  punishment.  This  is  a 
great  public  wrong,  because  each  judge  acts  on  his  own 
idea,  and  one  is  merciful  and  the  other  harsh.  If  it  is 
placed  by  law  in  the  breast  of  the  judges,  it  should  be  well- 
defined  and  regulated  by  statute.  Lord  MacKenzie  well 
says  :     "  The  discretion  of  a  judge  is  the  law  of  tyrants." 

3d.  It  will  be  observed  that  the  law  has  not  yet  judicially 
recognized  inebriety  as  a  disease,  except  in  the  cases  of 
delirium  tremens — above  cited — and  hardly  even  in  that 
case. 

It  is  for  publicists,  judges,  and  lawmakers  to  consider 
the  claim  now  made,  that  science  has  demonstrated  inebriety 
to  be  a  disease. 

If  this  is  conceded,  what  changes  are  needed  to  modify 
the  law,  as  it  at  present  stands,  so  as  to  fully  preserve  the 
rights  of  society,  in  its  relation  to  the  unlawful  acts  of  ine- 
briates, with  a  proper  and  just  sense  of  the  rights  of  the 
inebriate  himself  ? 

The  theoretical  superstition  that  more  severe  punish- 
ment of  inebriates  will  deter  them  from  drink  and  crime 
has  revived  again  in  many  sections. 

A  little  practical  investigation  will  show  that  every  ine- 
briate has  a  delusion  that  he  is  not  a  literal  drunkard,  but 
is  an  exception  to  others,  and  he  can  always  stop  at  will 
when  he  chooses.  He  never  realizes  that  any  application 
of  the  law  to  more  severe  punishment  will  have  any  refer- 
ence to  him.  He  never  believes  that  he  will  drink  to  excess 
or  violate  any  law — he  is  not  foolish  enough  for  that.     He 


284  DISEASES    OF   INEBRIETY. 

always  deludes  himself  with  the  idea  that  there  is  no  disease 
in  his  case,  and  all  his  use  of  spirits  is  the  result  of  acci- 
dents which  he  coulci  at  all  times  control.  Hence  all 
example  and  fear  of  the  law  are  powerless.  As  a  lawmaker 
and  judge  of  other  inebriates  he  is  unjustly  severe,  but  in 
his  own  case  he  is  always  an  exception,  and  will  never  come 
under  the  general  rule.  Confinement  or  even  capital  pun- 
ishment of  inebriates  has  never  a  personal  application  or  is 
an  example  in  the  minds  of  inebriates  who  do  not  suffer. 
Inebriates  who  are  sent  to  jail  regularly  every  year  for 
intoxication  always  delude  themselves  that  it  is  unjust  and 
the  result  of  accident  or  personal  revenge,  and  not  of 
violated  law. 

The  inebriate  who  is  punished  for  crime  always  consoles 
himself  with  the  faith  that  he  is  a  victim  of  plots  and  con- 
ditions that  should  have  been  otherwise. 

All  appreciation  of  themselves  when  intoxicated  is  con- 
fused and  cloudy,  and  hence  he  never  can  realize  that  he 
will  do  as  others  have  done  in  tliis  condition.  Tlie  theory 
of  deterring  these  men  by  increased  punishment  has  no 
support  practically  or  scientifically.  No  single  incident  has 
been  produced  to  show  that  such  an  effect  ever  follows  the 
practical  working  of  any  law  which  assumes  the  inebriate 
lias  the  power  to  stop  drinking,  and  can  be  forced  to  exer- 
cise it  by  intimidation  and  fear. 


CHAPTER   XXVIII. 

GENERAL     QUESTIONS    OF     IRRESPONSIBILITY. 

The  Importance  of  the  difficult  and  delicate  subject  of 
the  criminal  responsibility  of  inebriates  has  been  consider- 
ably enhanced  of  recent  years.  The  public  conscience  has 
been  shocked  by  the  severe  punishment  which  has  been 
inflicted  on  persons,  for  offenses  committed  without  any 
criminal  intention,  of  whicli  offenses  the  doer  had  no 
remembrance  when  he  awoke  from  his  drunken  paroxysm, 
and  of  the  commission  of  which  he  was  in  some  instances 
quite  unconscious,  in  other  instances  impelled  by  a  domin- 
ating narcomaniacal  impulse,  against  which  nothing  short 
of  physical  restraint  could  have  prevailed. 

The  marked  advance  made  by  this  special  question  has 
been  evidenced  by  the  interest  which  has  been  evoked  by 
the  publication  of  the  papers  read  to  the  Medico-Legal 
Society  of  New  York,  in  an  attractive  volume,  by  the  accom- 
plished president,  Mr.  Clark  Bell.  The  value  of  this  book 
is  the  greater  from  Mr.  Bell's  historical  account  of  the 
various  papers  presented  to  that  influential  and  useful 
society  (on  legal  relations  of  the  inebriate  in  business,  in 
social  affairs,  and  in  his  responsibility  before  the  law),  dur- 
ing the  last  two  decades.  This  interest  has  been  increased 
by  a  thoughtful  and  suggestive  brochure  on  the  impropriety 
of  inflicting  capital  punishment  on  inebriate  criminals,  by 
Dr.  T.  D.  Crothers.  There  has  been  no  general  rule  of 
law,  all  along  the  ages,  as  to  responsibility  for  offenses 
complicated    with  intoxication.     Roman    law    made    some 

285 


286  DISEASES    OF    INEBRIETY. 

allowance  for  drunkenness,  but  no  sucli  consideration  was 
exhibited  in  Grecian  jurisprudence.  Indeed,  in  Mitylene, 
under  Pittacus,  tliere  was  a  double  punisliment  for  crimes 
committed  wiiile  the  accused  was  intoxicated. 

In  the  United  States,  thougli  the  law  recognizes  no  plea 
of  responsibility  on  the  ground  of  drinking,  there  is  often 
manifested  a  practical  recognition  of  a  clironic  as  a  diseased 
drunkard  ;  and  in  capital  cases,  the  higher  penalty  of  the 
law  is  sometimes  avoided  by  a  verdict  of  murder  of  the 
second  degree.  New  York  State,  some  fifty  years  ago, 
classed  confirmed  drunkards  with  "  lunatics,  idiots,  and 
persons  of  unsound  mind,"  so  far  as  related  to  care  of  per- 
son and  property.  A  somewhat  similar  classification  is 
made  in  Manitoba. 

In  Germany  and  Switzerland  there  is  a  difference  in  the 
penalties  for  crimes  committed  in  culpable  and  inculpable 
intoxication.  By  Austrian  law,  the  accused  is  punished  for 
the  drunkenness  only,  provided  he  has  not  become  intoxi- 
cated for  the  purpose  of  committing  the  offense.  In  France, 
the  indicted  inebriate  is  shorn  of  civil  rights,  tiiough  there 
is  no  qualification  of  punishment  on  the  plea  of  drunken- 
ness. In  Sweden,  a  husband  can  be  divorced  for  inebriety, 
and  there  is  no  mitigation  of  penalty  from  alcoholic  com- 
plications. The  new  penal  code  of  Italy  enacts  that  in 
remission  of  punishment  on  account  of  intoxication  at  the 
time  when  the  alleged  criminal  act  is  done,  one-tiiird  of  the 
sentence  in  money  or  in  time  is  taken  off, 

English  jurisprudence  on  this  point  is  an  excellent 
exemplification  of  "  the  glorious  uncertainty  of  law."  In 
the  sixteenth  century  it  was  held  that  capital  punishment 
must  be  exacted  though  the  accused  was  drunk  and  igno- 
rant of  the  fatal  violence.  This  was  re-affirmed  by  Lord 
Mansfield  in  the  eighteenth  century,  he  holding  that  drunk- 
enness was  a  crime,  and  that  one  crime  could  not  be 
excused  by  another.  Coke  ruled  that  drunkenness  is  an 
aggravation,  and  being  an  artificially  contracted  madness, 


GENERAL     QUESTIONS    OF    IRRESPONSIBILITY.  287 

the  intoxicated  madman  is  a  volutitarius  dcetnon  and  there- 
fore responsible. 

In  later  times  judges  have  again  and  again  held  that 
drunkenness  is  no  excuse  for  crime,  and  that  a  criminal  act 
committed  in  a  fit  of  intoxication  is  as  rightly  punishable 
as  a  similar  act  done  when  the  accused  is  quite  sober.  For 
example,  a  man  while  he  was  drunk  killed  his  friend  who 
was  also  drunk,  imagining  that  the  latter  was  assaulting 
him  violently.  This  prisoner  was  found  guilty  of  man- 
slaughter on  the  ground  that  he  had  voluntarily  become 
intoxicated  (Reg  v.  Patterson,  Norfolk  Lent  Assizes, 
1840). 

This  exaction  of  full  responsibility  from  a  drunken  ac- 
cused on  the  ground  tiiat  drunkenness  is  a  voluntary  mad- 
ness, does  not  operate  fairly  or  justly  in  many  cases. 

If  drunkenness  were  always  a  voluntary  act  there  might 
be  something  in  such  a  contention  ;  but  this  state,  in  whicli 
confessedly  there  is  often  a  temporary  loss  of  reason  and 
consciousness,  is  not  invariably  avoidable. 

There  are  individuals  who  are  borne  involuntarily  on  a 
whirlwind  of  intoxication,  just  as  at  times  other  persons  are 
swept  off  their  equilibrium  by  a  maniacal  access.  In  the 
latter  case,  as  in  epileptic  mania,  if  it  can  be  established  that 
the  seizure  is  unavoidable,  and  the  consequent  actions  un- 
controllable, complete  responsibility  is  not  exacted.  In  some 
criminal  cases,  complicated  with  drinking,  the  intemperate 
outburst  during  which  the  crime  has  been  committed  has 
simply  been  as  utterly  beyond  the  control  of  the  person  as 
an  epileptic  maniacal  attack.  The  drunkenness  has  simply 
been  a  symptom  of  mental  unsoundness.  In  these  cases 
there  should  be  no  room  for  difference  of  opinion. 

In  other  cases,  though  there  has  been  no  insane  diathe- 
sis or  previous  insane  or  inebriate  paroxysm,  there  has  been 
a  temporarily  disordered  nervous  and  mental  condition 
which  lias  produced  a  temporarily  uncontrollable  impulse 
or  crave  for   narcotic   indulgence.     These  morbid  phenom- 


288  DISEASES   OF   INEBRIETY. 

ena  may  be  the  issue  of  a  variety  of  unavoidable  predis- 
posing or  exciting  causes.  For  example,  there  is  nerve 
exhaustion  and  brain  disturbance,  produced  in  some  persons 
by  excessive  and  continuous  watching  of  a  very  exacting 
invalid,  A  longer  or  shorter  period  of  constant  nursing 
without  sleep  may  so  affect  the  cerebro-spinal  centers  that 
the  nurse  may,  for  the  time,  be  hurled  into  a  drunken  fit  on 
the  m.ere  sipping  of  an  intoxicant,  of  which,  under  ordinary 
healthful  conditions,  she  could  partake  in  limited  quan- 
tities. 

In  the  disease  of  narcomania  (a  mania  for  any  kind  of 
narcotism),  inherited,  as  in  narcomania  of  the  neurotic  dia- 
thesis, there  is  apt  to  be  a  like  risk  of  extreme  susceptibil- 
ity to  the  narcotic  action  of  alcohol  and  other  anaesthetic 
intoxicants.  Is  it  equitable  that  no  allowance  should  be 
made  for  crime  committed  under  such  circumstances  ? 

But  over  and  above  this  inability  to  partake  of  an  alco- 
holic or  other  intoxicant  in  limited  quantity,  if  the  smallest 
sip  has  been  tasted,  there  remains  a  still  more  important 
phenomenon.  There  are  many  persons,  who,  from  various 
causes,  operating  physically  and  sometimes  even  in  spite  of 
efforts  at  resistance,  are  impelled  by  an  inward  irresistible 
impulse  to  rush  headlong  into  a  drunken  bout.  In  this 
transient  stage  of  inebriate  exascerbation  violence  may  be 
attempted.  All  admit  that  while  drunk  and  beside  them- 
selves these  accused  are  unconscious  of  evil  intention,  for  the 
simple  reason  that  consciousness  is  for  the  moment  practi- 
cally obliterated.  If  such  affected  persons  can  be  locked  up 
apart  from  intoxicants  for  a  given  number  of  hours  or  days 
they  are  safe  for  a  spell  ;  but  unless  restrained  by  superior 
force  they  cannot  resist  the  drink-impulse.  Is  it  just  that 
such  involuntary  criminals  should  be  punished  as  are  vol- 
untary evil-doers  ? 

Yet,  again  :  To  constitute  many  crimes  there  must  be 
an  illegal  intention.  How  can  this  be  present  when  a  man 
or  woman  is  so  drunk  as  to  be  incapacitated  to  reason  or  to 


GENERAL    QUESTIONS    OF    IRRESPONSIBILITY.  289 

remember,  or  even  to  be  conscious  of  what  he  or  she  does  ? 
In  a  recent  case,  where  there  was  a  sentence  of  twenty 
years  imprisonment, — equivalent  in  the  circumstances  to 
imprisonment  for  life, — two  men  had  been  drinking  together 
for  hours  at  various  bars.  While  at  dinner  in  the  evening, 
and  still  intoxicated,  one  of  tlie  drunkards  shot  the  other. 
Though  the  judge,  in  his  summing  up,  could  assign  no 
motive  for  the  deed,  the  survivor  of  this  fatal  alcoholic  duet 
was  found  guilty  and  sentenced  to  this  iieavy   punishment. 

Murder  is  sometimes  done  by  persons  who  are  laboring 
under  some  delusion  or  hallucination  begotten  of  the  nar- 
cotic brain-poisoning  under  which  tliey  are  laboring.  In 
one  case  an  educated  man  was  hung  for  a  deliberately 
executed  murder.  Though  the  fact  was  not  brought  out 
at  the  trial,  this  victim  of  the  law  had  been  suffering  from 
delusions  similar  to  those  which  I  have  seen  other  persons 
laboring  under  while  under  the  influence  of  chloral.  But 
in  these  latter  instances  the  patients  were  prevented  from 
doing  any  violence  by  the  watcliful  care  of  friends.  In  this 
class  of  cases  human  beings  may  suffer  the  higliest  penalty 
of  the  law  for  capital  offenses  of  which  they  had  no  per- 
sonal knowledge  at  the  time,  and  of  which  they  had  no 
remembrance  on  emerging  from  the  narcotic  influence. 

Reviewing  these  and  many  other  considerations  based 
on  physical  departures  from  health  which  operate  to  impair 
and  for  the  moment  destroy  the  moral  control,  and  which 
(temporarily,  it  may  be)  so  dull  the  consciousness  that  the 
doer  of  a  violent  deed  may  be  either  unaware  of  the  act 
itself,  or,  if  he  is  aware  of  it,  his  reason  may  be  so  con- 
fused that  he  is  unable  to  understand  the  consequences  or 
the  nature  of  the  act.  Or,  again,  if  conscious  and  able  to 
understand  the  character  and  effects  of  the  act,  his  will  may 
be  so  paralyzed  as  to  be  powerless  to  resist  the  morbid 
impulse.  Passing  all  this  under  review,  it  is  most  gratifying 
to  scientific  students  of  medical  jurisprudence,  to  find  a 
gradually  increasing  disposition  in  judge  and  jury  to  allow 


290  DISEASES    OF    INEBRIETY. 

scientific  discoveries  to  influence  their  judgments.  Mr. 
Justice  Day,  for  excimple,  recently  ruled  that  "  whatever 
the  cause  of  the  unconsciousness,  a  person  not  knowing  the 
nature  and  quality  of  his  acts,  is  irresponsible  for  them  " 
(Reg.  V.  Barnes,  Lancaster  Assizes,  January,  1886).  If  this 
ruling  were  acquiesced  in  by  other  judges,  and  if  juries 
acted  on  this  ruling,  then  a  considerable  proportion  of 
cases  in  which  criminal  offences  have  been  committed  while 
the  doer  was  in  a  state  of  drunken  unconsciousness  and 
was  tl'.erefore  innocent  of  a  criminal  design,  or  of  any  actual 
present  knowledge  of  the  deed,  would  at  once  be  removed 
from  the  category  in  wliich  they  have  hitherto  been  almost 
always  placed,  that  of  complete  responsibilitv,  involving  full 
penalties,  and  treated  as  irresponsible.  Indeed,  the  general 
following  of  such  an  enlightened  ruling  would  amount  to  a 
revolution  in  our  present  criminal  procedure. 

As  remarkable  a  judicial  deliverance  was  that  of  Chief 
Baron  Tolles  (Reg.  v.  M.  R.,  Galway  Summer  Assizes,  1887). 
The  defendant,  a  female  nurse,  was  accused  of  killing  a 
male  patient  who  was  under  her  care  for  typhus  fever.  The 
evidence  showed  that  for  over  seven  days  she  had  nursed 
the  invalid  day  and  night,  that  one  night  half  a  glass  of 
whiskey  was  given  to  her,  and  the  bottle  with  five  glasses 
remaining  in  it  was  left  on  the  kitchen  dresser.  The  dying 
man  was  in  charge  of  his  mother  and  the  nurse  during  the 
night,  when  all  else  in  the  house  had  retired  to  rest.  The 
mother,  who  was  quite  worn  out,  slept  in  another  room, 
and  was  awoke  early  in  the  morning  by  the  nurse  screaming. 
She  found  her  son's  dead  body  on  the  kitchen  floor,  sur- 
rounded by  fire.  The  nurse  was  screaming  and  dancing 
about,  with  a  brush  in  one  hand  and  a  pair  of  tongs  in  the 
other.  The  nurse  was  very  excited  and  appeared  either 
mad  or  drunk.  From  other  witnesses  it  was  elicited  that 
the  nurse  cried  out,  "  she'd  soon  have  the  devil  burnt  and 
M.  D.  back  again." 

The  judge  charged  that  drunkenness  being  a  voluntary 


GENERAL    QUESTIONS   OF   IRRESPONSIBILITY.  291 

act,  the  law  held  persons  responsible  for  acts  done  in  a  state 
voluntarily  produced,  though  they  did  not  know  the  nature 
and  quality  of  their  acts.  But  that,  if  a  person,  from  any 
cause,  say  long  watching,  want  of  sleep,  or  deprivation  of 
blood,  was  reduced  to  such  a  condition  that  a  smaller 
quantity  of  stimulant  would  make  him  drunk  than  would 
produce  such  a  state  if  he  were  in  health,  then  neither  law 
nor  common  sense  would  hold  him  responsible  for  his  acts 
inasmuch  as  they  were  not  voluntary  hut  produced  by  disease. 
It  appeared  from  the  evidence  that  the  nurse  was  under  the 
delusion  that  her  patient  had  been  turned  into  a  devil,  that 
the  proper  course  was  to  burn  the  devil  and  thus  bring 
back  the  patient.  Was  that  delusion  the  result  of  drunken- 
ness or  of  disease  of  the  mind  ?  The  jury  found  the 
prisoner  guilty  of  manslaughter,  but  insane  at  the  time  of 
committing  it,  and  she  was  ordered  to  be  confined  in  a 
lunatic  asylum  during  the  Lord  Lieutenant's  pleasure. 

Here  again  is  a  decision  affecting  a  wide  circle  of  crim- 
inal accusations.  In  former  times  the  accused  has  suffered 
severe  penalties  in  such  cases,  but  Baron  Tolles'  recognition 
of  a  diseased  condition  and  of,  so  to  speak,  an  accidental 
involuntary  intoxication  as  entitling  to  criminal  irresponsi- 
bility is  a  remarkable  event  in  our  criminal  annals. 

Let  me  just  call  your  attention  to  one  more  evidence  of 
the  growing  influence  of  the  discoveries  of  modern  patho- 
logical scientific  research  on  the  judicial  mind.  This  case  is 
an  excellent  illustration  of  the  extraordinary  advance  in 
medical  jurisprudence, recognizing  as  it  does  the  influence 
oi  heredity  \n  modifying  criminal  responsibility. 

An  unmarried  man,  aged  thirty-four,  was  charged  with 
killing  his  mother,  with  prolonged  violence,  in  the  presence 
of  a  terror-stricken  servant,  whom  he  had  locked  up  in  the 
room  witii  them  all  night.  About  five  years  previously  the 
prisoner  had  an  attack  of  delirium  tremens,  and  for  a  year 
past  had  been  subject  to  excited  fits  and  delusional  fears  as 
to  his  life  having  been  threatened.     He  persisted  in  declar- 


292  DISEASES    OF   INEBRIETY. 

iiig  tliat  the  victim  was  not  his  mother.  One  medical  witness 
testified  that  the  accused  was  laboring  under  a  seizure  of 
delirium  tremens  when  the  murder  was  done.  Another 
testified  that  he  believed  the  form  of  the  prisoner's  illness 
was  mania-a-potu.  Evidence  was  adduced  in  proof  of  an 
insane  heredity. 

Baron  Tollock,  in  his  charge,  said  that  though  no  man 
could  be  excused  on  the  mere  plea  that  he  had  reduced 
himself  to  want  of  reason  by  drinking,  there  were  other 
circumstances  in  the  present  case.  One  was  that  through 
hereditary  influence  the  accused's  infirmity  and  mental 
deterioration  possibly  did  largely  account  for  the  violent 
act.  Another  circumstance  was  whether,  apart  from  drink- 
ing, the  man  was  the  subject  of  delusional  insanity.  The 
judge  most  judiciously  answered  the  objection  that  if  the 
prisoner  had  been  an  abstainer  from  alcoholic  drink  he 
would  not  have  been  guilty  of  killing  his  mother  ;  that,  as 
a  certain  amount  of  alcohol  with  his  predisposition  made 
him  a  murderer,  the  accused  should  not  have  taken  ilie  little 
drop  that  upset  his  reason.  Baron  Tollock  replied  that  the 
last  man  to  know  his  own  weakness  is  he  who  has  a  weak 
mind,  that  such  an  one  cannot  argue  as  doctors  can  argue 
for  him,  but  believes  that  as  regards  strength  of  mind  he  is 
on  a  par  with  all  around  him.  The  learned  judge  charged 
that  if  at  the  time  when  the  murder  was  committed  (though 
the  accused  had  been  a  drunkard  and  had  suffered  from 
delirium  tremens)  he  had  drank  only  such  a  quantity  of 
intoxicant  liquor  as  an  ordinary  man  could  take  without 
upsetting  his  reason,  and  that  the  insane  predisposition  was 
tlie  main  factor,  although  the  drinking  of  a  small  quantity 
of  alcohol  was  a  contributary  cause,' the  plea  of  irresponsi- 
bility on  the  ground  of  insanity  was  good.  Happily  the 
jury  returned  a  verdict  of  acquittal  in  accordance  with 
the  judge's  charge. 

To  these  encouraging  deliverances  ought  to  be  added 
others  of  an  earlier  date,  though  those  were  referable  to  a 


GENERAL    QUESTIONS    OF    IRRESPONSIBILITY.  293 

special  alcoholic  disease  as  freeing  from  responsibility. 
Though  in  some  cases  a  plea  based  on  delirium  tremens  has 
not  been  allowed,  in  other  cases,  such  as  the  following,  this 
plea  has  been  pronounced  valid.  In  Reg.  v.  Burns  (Liver- 
pool Summer  Assizes,  1865),  the  accused  had  killed  his  wife, 
and  immediately  thereafter  appeared  to  be  quite  calm, 
coolly  stating  that  he  knew  what  he  had  done,  and  giving 
as  his  reason  for  the  deed  that  she  was  in  league  with  men 
concealed  in  the  walls.  The  jury  acquitted  the  prisoner  on 
the  ground  laid  down  by  Baron  Bramwell  that,  though  the 
accused  might  have  known  that  the  act  was  killing  and  was 
wrong,  he  was  laboring  under  a  delusion  which  led  him  to 
suppose  that  the  delusion,  if  true,  would  have  justified  the 
action. 

Another  person  was  acquitted  of  feloniously  wounding 
two  individuals,  on  the  plea  that  he  was  under  the  impres- 
sion, from  delirium  tremens,  that  his  house  was  being 
broken  into. 

At  the  Liverpool  Assizes,  May,  1888,  the  jury  found  a 
verdict  of  "  not  guilty  "  in  the  case  of  a  lady  of  independent 
fortune,  on  the  ground  that  she  had  recently  suffered  from 
delirium  tremens,  had  not  quite  recovered  therefrom,  and 
was  incapable  of  knowing  what  she  was  doing.  The  alleged 
offence  was  theft  of  a  purse,  a  knife,  a  diamond  ring,  and 
three  shillings  in  cash. 

Turn  we  now  to  our  police-courts.  Our  present  practice 
of  dealing  with  drunkards  there  is  as  misciiievous  as  it  is 
unjust.  I  am  informed  by  Dr.  J.  Francis  Sutherland,  that 
in  my  native  city,  Glasgow,  there  are  some  10,000  annual 
commitments  of  intemperate  women  for  drunkenness  and 
offences  connected  therewith,  for  an  average  period  of  seven 
days.  On  an  average  each  female  is  imprisoned  three  times 
in  a  year.  Some  forty  per  cent,  of  these  prisoners  have  had 
from  eleven  to  800  previous  convictions.  What  does  this 
really  mean  ?  Simply  tliat,  so  far  from  curing  or  reforming, 
these  short  sentences  actually  only  suffice  to  allow  the  incar- 


294  DISEASES    OF    INEBRIETY. 

cerated  to  recover  from  the  effects  of  a"  drinking  bout,"  and 
send  them  forth  once  more  witli  renewed  vigor  to  resume 
their  drunken  excesses. 

Our  police-court  procedure  in  such  cases  is  a  mere  mock- 
ery of  justice,  a  huge  system  for  the  governmental  training 
of  inebriates.  All  this  is  most  unfair.  When  a  fine  is  ex- 
acted the  real  sufferers  are  the  children  of  the  prisoner,  who 
often  deny  themselves  necessary  food  to  gather  together  the 
amount  of  their  parent's  fine.  When  there  is  a  term  of 
imprisonment,  the  famil)''  are  again  the  punished,  for  their 
means  of  subsistence  is  taken  from  them  by  tiie  internment 
of  the  bread-winner.  The  latter  is  practically  not  punished, 
prison  being  but  a  "  club  "  wliere  he  is  provided  with  whole- 
some food,  free  apartments,  and  healthful  discipline,  to  say 
nothing  of  gratuitous  medical  attendance. 

Looking  at  our  existing  general  criminal  treatment  of 
inebriety,  there  can  be  little  doubt  that  it  is  altogether  an 
error,  and  founded  on  a  wrong  conception  of  what  drunken- 
ness usually  is.  Science  is  day  by  day  showing  more  clearly 
that  intemperance  is  generally  the  effect  of  disease,  the  inev- 
itable outcrop  of  an  unhealthy  condition  of  body  or  brain 
or  both.  To  exact  full  criminal  accountability  from  a  culprit 
"tvhose  temporary  unconsciousness. and  lack  of  control  have 
been  in  the  main  due  to  certain  physical  perversions,  tem- 
porarily or  permanently  affecting  his  reason,  is  as  prejudicial 
to  the  individual  as  it  is  costly  and  demoralizing  to  the  com- 
munity, and  as  futile  as  it  is  unrighteous. 

The  legislature,  by  licensing  the  common  sale  of  intoxi- 
cating drinks,  tempts  to  their  destruction  human  beings  too 
scantily  endowed  with  resisting-power  to  withstand  such 
tremendous  temptations,  and  having  trained  them  in  ine- 
briety, exacts  from  them  full  responsibilit}^  for  all  criminal 
acts  thus  committed  and  developed  under  the  iFgis  of  the 
law.  Is  tliis  intelligent,  honorable,  or  fair  ?  I  trow  not  ; 
and  I  look  forward  with  confidence,  a  confidence  heightened 
by  a  recollection  of  the  remarkable  tributes  of   the  judicial 


GENERAL    QUESTIONS    OF   IRRESPONSIBILITY.  295 

bench  to  science,  to  which  I  have  just  referred,  to  the  not  far 
distant  future,  when  every  diseased  inebriate  accused  of  a 
criminal  offence  shall  receive  that  fair  consideration  at  the 
hands  of  our  legal  tribunals,  which  a  rigliteous  administra- 
tion of  justice  owes  to  even  the  least  deserving  and  the 
meanest  panel  at  the  bar. 


CHAPTER  XXIX. 

SOME     FORMS      OF      IRRESPONSIBILITY — ALCOHOLIC 
TRANCE. 

The  frequent  statement  of  prisoners  in  court  that  they 
did  not  remember  anything  about  the  crime  they  are  accused 
of,  appears  from  scientific  study  to  be  a  psychological  fact. 
How  far  tiiis  is  true  in  all  cases  has  not  been  determined, 
but  there  can  be  no  question  that  crime  is  often  committed 
without  a  conscious  knowledge  or  memory  of  the  act  at  the 
time. 

It  is  well  known  to  students  of  mental  science,  that  in 
certain  unknown  brain  states  memory  is  palsied,  and  fails 
to  note  the  events  of  life  and  surroundings.  Like  the  som- 
nambulist, tlie  person  may  seem  to  realize  his  surroundings 
and  be  conscious  of  his  acts,  and  later  be  unable  to  recall 
anything  which  has  happened.  These  blanks  of  memory 
occur  in  many  disordered  states  of  the  brain  and  body,  but 
are  usually  of  such  short  duration  as  not  to  attract  attention. 
Sometimes  events  that  occur  in  this  state  may  be  recalled 
afterwards,  but  usually  they  are  total  blanks.  The  most 
marked  blanks  of  memory  have  been  noted  in  cases  of  epi- 
lepsy and  inebriety.  When  they  occur  in  the  latter  they 
are  called  Alcoholic  Trances^  and  are  always  associated  with 
excessive  use  of  spirits. 

Such  cases  are  noted  in  persons  who  use  spirits  continu- 
ously, and  who  go  about  acting  and  talking  sanely  although 
giving  some  evidence  of  brain  failure,  yet  seem  to  realize 
their  condition  and  surroundings.  Some  time  after,  they 
wake  up  and   deny  all   recollection   of  acts  or  events  for  a 

297 


298  DISEASES    OF   INEBRIETY. 

certain  period  in  the  past.  This  period  to  them  begins  at 
a  certain  point  and  ends  iiours  or  days  after,  the  interval  of 
which  is  a  total  blank,  like  that  of  unconscious  sleep. 
Memory  and  certain  brain  functions  are  suspended  at  this 
time,  while  the  other  brain  activities  go  on  as  usual. 

In  all  probability  the  continued  paralysis  from  alcohol 
not  only  lowers  the  nutrition  and  functional  activities  of  the 
brain,  but  produces  a  local  palsy,  followed  by  a  temporary 
failure  of  consciousness  and  memory,  which  after  a  time 
passes  away. 

When  a  criminal  claims  to  have  had  no  memory  or 
recollection  of  the  crime  for  which  he  is  accused,  if  his 
statement  is  true,  one  of  two  conditions  is  probably  present, 
either  epilepsy  or  alcoholism.  Such  a  trance  state  might 
exist  and  the  person  be  free  from  epilepsy  and  alcoholism, 
but  from  our  present  knowledge  of  this  condition  it  would 
be  difficult  to  determine  this  fact.  If  epilepsy  can  be  traced 
in  the  histor}'  of  the  case,  the  trance  state  has  a  patho- 
logical basis  for  its  presence.  If  the  prisoner  is  an  in- 
ebriate, the  same  favoring  conditions  are  present.  If  the 
prisoner  has  been  insane,  and  suffered  from  sun  or  heat 
stroke,  and  the  use  of  spirits  are  the  symptoms  of  brain 
degeneration,  the  trance  state  may  occur  any  time. 

The  fact  of  the  actual  existence  of  the  trance  state  is  a 
matter  for  stud}^  to  be  determined  from  a  history  of  the 
person  and  his  conduct  ;  a  grouping  of  evidence  that  the 
person  can  not  simulate  or  falsify  ;  evidence  that  turns  not 
on  any  one  fact,  but  on  an  assemblage  of  facts  that  point 
to  the  same  conclusion. 

The  following  cases  are  given  to  illustrate  some  of  these 
facts,  which  support  the  assertion  of  no  memory  of  the  act 
by  the  prisoner  in  court  : 

The  first  case  is  that  of  A.,  who  was  repeatedly  arrested 
for  horse  stealing,  and  always  claimed  to  be  unconscious  of 
the  act.  This  defense  was  regarded  with  ridicule  by  the 
court  and  jury,  and  more  severe  sentences  were  imposed, 


SOME   FOEMS    OF   IRRESPONSIBILITY.  299 

until,  finally,  he  died  in  prison.  The  evidence  offered  in 
different  trials  in  defense  was,  tliat  his  fatlier  was  weak- 
minded  and  died  of  consumption,  and  liis  motiier  was  insane 
for  many  years,  and  died  in  an  asylum.  His  early  life  was 
one  of  hardship,  irregular  living,  and  no  training.  At 
sixteen  he  entered  tlie  army,  and  suffered  from  exposure, 
disease,  and  sunstrol<e,  and  began  to  drink  spirits  to  excess 
at  tliis  time.  At  twenty  lie  was  employed  as  a  hack-driver, 
and  ten  years  later  became  owner  of  a  livery  stable.  He 
drank  to  excess  at  intervals,  yet  during  this  time  attended 
to  business,  acting  sanely  and  apparently  conscious  of  all 
his  acts,  but  often  complained  he  could  not  recollect  what 
he  had  done  while  drinking.  When  about  thirty-four  years 
of  age  he  would,  while  drinking,  drive  strange  horses  to  his 
stable,  and  claim  that  he  had  bought  them.  The  next  day 
he  had  no  recollection  of  these  events,  and  made  efforts  to 
find  the  owners  of  these  horses  and  return  them.  It 
appeared  that  while  under  the  influence  of  spirits  the  sight 
of  a  good  horse  hitched  up  by  the  roadside  alone,  created 
an  intense  desire  to  possess  and  drive  it.  If  driving  his  own 
horse,  he  would  stop  and  place  it  in  a  stable,  then  go  and 
take  the  new  horse,  and  after  a  short  drive  put  it  up  in  his 
own  stable,  then  go  and  get  his  own  horse. 

The  next  day  all  this  would  be  a  blank,  which  he  could 
never  recall.  On  several  occasions  he  displayed  reasoning 
cunning.  In  not  taking  a  horse  when  the  owners  or  drivers 
were  in  sight.  This  desire  to  possess  the  horse  seemed 
under  control,  but  when  no  one  was  in  sight  all  caution 
left  him,  and  he  displayed  great  boldness  in  driving  about 
in  the  most  public  way.  If  the  owner  should  appear  and 
demand  his  property  he  would  give  it  up  in  a  confused, 
abstract  way.  No  scolding  or  severe  language  made  any 
impression  on  him.  Often,  if  the  horse  seemed  weary,  he 
would  place  it  in  the  nearest  stable,  with  strict  orders  to 
give  it  special  care.  On  one  occasion  he  joined  in  a  search 
of  a   stolen   horse,  and    found   it  in  a  stable   where   he  had 


300  DISEASES   OF  INEBRIETY. 

placed  it  many  days  before.  Of  this  he  had  no  recollection. 
In  another  instance  he  sold  a  horse  which  he  had  taken, 
but  did  not  take  any  money,  making  a  condition  that  the 
buyer  should  return  the  horse  if  he  did  not  like  it.  His 
horse  stealing  was  all  of  this  general  character.  No  motive 
was  apparent,  or  effort  at  concealment,  and  on  recovering 
from  his  alcoliolic  excess,  he  made  every  effort  to  restore 
the  property,  expressing  great  regrets  and  paying  freely  for 
all  losses.  Tlie  facts  of  these  events  fully  sustained  his 
assertion  of  unconsciousness,  yet  his  apparent  sanity  was 
made  the  standard  of  his  mental  condition.  The  facts  of 
his  heredity,  drinking,  crime,  and  conduct  all  sustained 
his  assertion  of  unconsciousness  of  these  events.  This  was 
an  alcoholic  trance  state,  with  kleptomaniac  impulses. 

The  next  case,  that  of  B.,  was  executed  for  the  murder 
of  his  wife.  He  asserted  positively  that  he  had  no  memory 
or  consciousness  of  the  act,  or  any  event  before  or  after. 
The  evidence  indicated  that  he  was  an  inebriate  often  years 
duration,  dating  from  a  sunstroke.  He  drank  periodically, 
for  a  week  or  ten  days  at  a  time,  and  during  this  period  was 
intensely  excitable  and  active.  He  seemed  always  sane  and 
conscious  of  his  acts  and  surroundings,  although  intensely 
suspicious,  exacting,  and  very  irritable  to  all  his  associates. 
When  sober  he  was  kind,  generous  and  confiding,  and  never 
angry  or  irritable.  He  denied  all  memory  of  his  acts  during 
this  period.  While  his  temper,  emotions,  and  conduct  were 
greatly  changed  during  this  time,  his  intellect  seemed  more 
acute  and  sensitive  to  all  his  acts  and  surroundings.  His 
business  was  conducted  with  usual  skill,  but  he  seemed  un- 
able to  carry  out  any  oral  promises,  claiming  he  could  not 
recollect  them.  His  business  associates  always  put  all  bar- 
gains and  agreements  in  writing  when  he  was  drinking,  for 
the  reason  he  denied  tliem  when  sober.  But  when  not 
drinking  his  word  and  promise  was  always  literally  carried 
out.  He  broke  up  the  furniture  of  his  parlor  when  in  this 
State,  and  injured  a  trusted  friend,  and  in  many  ways  showed 


SOME   FOEMS   OF   lEEESPONSIBILITY.  301 

violence  from  no  cause  or  reason,  and  afterwards  claimed 
no  memory  of  it. 

After  these  attacks  were  over,  he  expressed  great  alarm 
and  sought  in  every  way  to  repair  tlie  injury.  Finally  he 
struck  his  wife  witli  a  chair  and  killed  her,  and  awoke  the 
next  day  in  jail,  and  manifested  the  most  profound  sorrow. 
While  he  disclaimed  all  knowledge  of  the  crime,  he  was 
anxious  to  die  and  welcome  his  execution.  This  case  was  a 
periodical  inebriate  with  maniacal  and  homicidal  tenden- 
cies. His  changed  conduct,  and  unreasoning,  motiveless 
acts,  pointed  to  a  condition  of  trance.  His  assertion  of  no 
memory  was  sustained  by  his  conduct  after  and  efforts  to 
find  out  what  he  had  done  and  repair  the  injury. 

The  third  case,  that  of  C,  was  a  man  of  wealth  and 
character,  who  forged  a  large  note,  drew  the  money  and 
went  to  a  distant  city  on  a  visit.  He  was  tried  and  sen- 
tenced to  State  prison.  Tlie  defense  was  no  memory  or 
consciousness  of  the  act,  by  reason  of  excessive  use  of  alco- 
hol. This  was  treated  with  ridicule.  Although  he  had 
drank  to  excess  at  the  time  and  before  the  crime,  he 
seemed  rational  and  acted  in  no  way  as  if  he  did  not  under- 
stand what  he  was  doing.  Both  his  parents  were  neurotics, 
and  he  began  to  drink  in  early  life,  and  for  years  was  a 
moderate  drinker.  He  was  a  successful  manufacturer,  and 
only  drank  to  excess  at  times  for  the  past  five  years.  He 
complained  of  no  memory  during  these  drink  paroxysms, 
and  questioned  business  transactions  and  bargains  he  made 
at  this  time.  On  one  occasion  he  went  to  New  York  and 
made  foolish  purchases  which  he  could  not  recall.  On 
several  occasions  he  discharged  valuable  workmen,  and 
when  he  became  sober  took  them  back,  unable  to  account 
for  such  acts. 

These  and  other  very  strange  acts  continued  to  increase 
with  every  drink  excess.  At  such  times  he  was  reticent  and 
seemed  to  be  sensible  and  conscious,  and  did  these  strange 
acts    in   a   sudden,  impulsive    way.     The   forged   note    was 


302  DISEASES   OF   INEBRIETY. 

offered  boldly,  and  no  effort  was  made  to  conceal  his  pres- 
ence or  destination.  When  arrested,  he  was  alarmed  and 
could  not  believe  that  he  had  done  so  foolish  an  act.  This 
was  a  clear  case  of  alcoholic  trance,  in  whicli  all  the  facts 
sustained  his  assertion  of  no  conscious  memory  of  the  crime. 
In  these  three  cases  the  correctness  of  tlie  prisoner's  asser- 
tions of  no  memory  was  verified  by  all  the  facts  and  circum- 
stances of  the  crime.  The  mere  statement  of  a  person 
accused  of  crime,  that  he  had  no  memory  of  the  act,  should 
lead  to  a  careful  examination  and  be  only  accepted  as  a 
fact  when  it  is  supported  by  other  evidence. 

The  following  case  illustrates  the  difficulty  of  support- 
ing a  prisoner's  statement  of  no  memory  when  it  is  used  for 
purposes  of  deception  : 

Case  E.  An  inebriate  killed  a  man  in  a  fight,  and  was 
sentenced  to  prison  for  life.  He  claimed  no  memory  or 
recollection  of  the  act.  I  found  that  when  drinking  he 
seemed  conscious  of  all  his  surroundings,  and  was  always 
anxious  to  conceal  his  real  condition,  and  if  anything  had 
happened  wliile  in  this  state  he  was  very  active  to  repair 
and  hush  it  up.  He  was  at  times  quite  delirious  when 
under  tlie  influence  of  spirits,  but  would  stop  at  once  if  any 
one  came  along  that  he  respected.  He  would,  after  acting 
wildly,  seem  to  grow  sober  at  once,  and  do  everything  to 
restore  the  disorder  he  had  created.  The  crime  was  an 
accident,  and  at  once  he  attempted  concealment,  ran  away, 
changed  his  clothing,  and  tried  to  disguise  his  identity  ; 
when  arrested,  claimed  no  memory  or  consciousness  of  the 
act.  This  claim  was  clearly  not  true,  and  contradicted  by 
the  facts. 

In  a  recent  case,  F.  shot  his  partner  in  business  while  both 
were  intoxicated,  and  displayed  great  cunning  to  conceal 
the  crime  and  person  ;  then,  after  elaborate  preparations, 
went  away.  He  made  the  same  claim  of  defense,  whicli  was 
unsupported  by  any  other  evidence  or  facts  in  his  previous 
life.     He  was   executed.     Of  course  it  is  possible   for  th^ 


SOME    FOKMS    OF    IRRESPONSIBILITY.  303 

trance  state  to  come  on  suddenly,  and  crime  be  committed 
at  tliis  time  ;  still,  so  far,  all  the  cases  studied  show  that 
this  condition  existed  before,  and  was  the  product  of  a 
growth  beginning  in  brief  blanks  of  a  few  moments  and 
extending  to  hours  and  days  duration.  Unless  the  facts 
indicated  the  trance  state  before  the  crime  was  committed, 
it  would  be  difficult  to  establish  this  condition  for  the  first 
time,  followed  and  associated  with  the  crime. 

I  think  in  most  of  these  cases,  where  this  defense  is  set 
up,  there  will  be  found  certain  groups  of  cases  that  have 
common  physical  conditions  of  degeneration.  These  groups 
of  cases  I  have  divided  from  a  clinical  standpoint,  the  value 
of  which  will  be  more  as  an  outline  for  future  studies. 

Probably  the  largest  number  of  criminal  inebriates  who 
claim  loss  of  memory  as  a  defense  for  their  acts,  are  the  alco- 
holic dements.  This  class  are  the  chronic  inebriates  of  long 
duration  ;  persons  who  have  naturally  physical  and  mental 
defects,  and  who  have  used  spirits  to  excess  for  years. 
This,  with  bad  training  in  early  life,  bad  surroundings,  and 
bad  nutrition,  have  made  them  of  necessity  unsound,  and 
liable  to  have  many  and  complex  brain  defects.  Such  per- 
sons are  always  more  or  less  without  consciousness  or 
realization  of  their  acts.  They  act  automatically  only, 
governed  by  the  lowest  and  most  transient  impulses. 
Crimes  of  all  kinds  are  generally  accidents  growing  out  of 
the  surroundings,  without  premeditation  or  plan.  They 
are  incapable  of  sane  reasoning  or  appreciation  of  the  results 
of  their  conduct.  The  crime  is  unreasoning,  and  general 
indifference  marks  all  their  acts  afterwards.  The  crime  is 
always  along  lines  of  previous  conduct,  and  never  strange 
or  unusual.  The  claim  of  no  memory  in  such  cases  has 
always  a  reasonable  basis  of  truth  in  the  physical  conditions 
of  the  person.  Mania  is  very  rarely  present,  but  delusions 
and  morbid  impulses  of  a  melancholic  type  always  exist. 
The  mind,  like  tlie  body,  is  exliausted,  depressed,  and  acts 
along  lines  of  least  resistance. 


304  DISEASES    OF   INEBRIETY. 

The  second  group  of  criminals  who  cUiim  no  memory 
are  those  where  the  crime  is  unusual,  extraordinar}^  and 
unforeseen.  Persons  who  are  inebriates  suddenly  commit 
murder,  steal,  or  do  some  criminal  act  that  is  foreign  to  all 
previous  conduct.  In  such  cases  the  trance  condition  may 
have  been  present  for  some  time  before  and  escaped  any 
special  notice,  except  the  mere  statement  of  the  person  that 
he  could  not  recollect  his  acts.  The  unusual  nature  of  the 
crime,  committed  by  persons  who  never  before  by  act  or 
thought  gave  any  indication  of  it,  is  always  a  factor  sus- 
taining the  claim  of  no  memory.  The  explosive,  unreason- 
ing cliaiacter  of  crime  always  points  to  mental  unsoundness 
and  incapacity  of  control. 

A  third  group  of  criminals  urge  this  statement  of  no 
memory,  who,  unlike  the  first  group,  are  not  imbeciles, 
generally.  They  are  positive  inebriates,  drinking  to  excess, 
but  not  to  stupor,  who  suddenly  commit  crime  with  the 
most  idiotic  coolness  and  indifference,  never  manifesting 
the  slightest  appreciation  of  the  act  as  wrong,  or  likel}'^  to 
be  followed  by  punishment.  Crime  committed  by  this  class 
is  never  concealed,  and  the  criminal's  after  conduct  and 
appearance  gives  no  intimation  that  he  is  aware  of  what  he 
has  done.  These  cases  have  been  termed  moral  paralytics, 
and  the  claim  of  the  trance  state  may  be  very  likely  true. 

A  fourth  group  of  cases,  where  memory  is  claimed  to  be 
absent,  occurs  in  dipsomaniacs  and  periodical  inebriates, 
who  have  distinct  free  intervals  of  sobriety.  This  class 
begin  to  drink  to  great  excess  at  once,  then  drink  less  for  a 
day  or  more,  and  begin  as  violently  as  ever  again.  In  this 
short  interval  of  moderate  drinking  some  crime  is  committed 
which  they  claim  not  to  have  any  recollection. 

Other  cases  have  been  noted  where  a  condition  of  mental 
irritation  or  depression  preceded  the  drink  explosion,  and 
the  crime  was  committed  during  this  premonitory  period  and 
before  they  drank  to  excess.  The  strong  probability  of  trance 
at  this  period  is  sustained  by  the  epileptic  character  of  such 


SOME    FORMS    OF    IRRESPONSIBILITY.  305 

conduct  afterwards.  The  trance  may  be  justly  termed  a 
species  oi  aura,  or  bva.in  paralysis,  which  precedes  the  explo- 
sion. 

In  some  instances,  before  the  drink  storm  comes  on,  the 
person's  mind  would  be  filled  with  the  most  intense  suspic- 
ions, fears,  delusions,  and  exhibit  a  degree  of  irritation  and 
perturbation  unusual  and  unaccountable.  Intense  excite- 
ment for  depression,  from  no  apparent  cause,  prevails,  and 
during  this  period  some  crime  may  be  committed  ;  then 
comes  the  drink  paroxysm,  and  later  all  the  past  is  a  blank. 
Trance  is  very  likely  to  be  present  at  this  time. 

In  these  groups  the  crime  is  generally  automatic,  or 
committed  in  a  manner  different  from  other  similar  crimes. 
Some  governing  center  has  suspended,  and  all  sorts  of 
impulses  may  merge  into  acts  any  moment.  The  conscious- 
ness of  acts  and  their  consequences  are  broken  up.  The 
strong  probability  is  tliat  these  trance  blanks  begin  in  short 
periods  of  unconsciousness,  which  lengthen  with  the  degener- 
ation and  mental  feebleness  of  the  person.  The  obscurity 
of  these  conditions,  and  the  incapacity  of  the  victims  to 
realize  their  import,  also  the  absence  of  any  special  study, 
greatly  increases  the  difficult}'.  It  will  be  evident  from 
inquiry  that  trance  states  among  inebriates  are  common, 
but  seldom  attract  attention,  unless  they  come  into  legal 
notice. 

The  practical  question  to  be  determined  in  a  given  case 
in  court  is  the  actual  mental  condition  of  the  prisoner,  who 
claims  to  have  no  recollection  of  the  crime.  This  is  a  class 
of  evidence  that  must  be  determined  by  circumstantial  and 
collateral  facts,  which  require  scientific  expertness  to  gather 
and  group.  The  court  can  decide  from  the  general  facts  of 
the  crime  and  the  prisoner  whether  his  claim  of  no  memory 
may  possibly  be  true,  and  order  an  expert  examination  to 
ascertain  the  facts.  Tliis  should  be  done  in  all  cases  where 
the  prisoner  is  without  means,  in  the  same  way  that  a 
lunacy  commission  is  appointed    to    decide    upon    insanity. 


306  DISEASES    OF   INEBRIETY. 

The  result  of  this  expert  study  may  show  a  large  prepon- 
derance of  evidence  sustaining  the  claim  of  no  memory,  or 
the  opposite.  If  the  former,  the  measure  of  the  responsi- 
bility must  be  modified,  and  the  degree  of  punishment 
changed.  While  such  cases  are  practically  insane  at  the 
time,  and  incapable  of  realizing  or  controlling  their  acts, 
they  should  be  kept  under  legal  and  medical  surveillance 
for  a  lifetime,  if  necessary.  Such  men  are  dangerous,  and 
sliould  be  carefully  wratched  and  deprived  of  their  liberty 
for  a  length  of  time  depending  on  recovery  and  capacity  to 
act  rationally  and  normally.  They  are  dangerous  diseased 
men,  and,  like  victims  of  contagious  disease,  must  be  housed 
and  treated. 

The  future  of  such  cases  depends  on  the  removal  of  the 
causes  w^hich  made  them  what  they  are.  The  possibility  of 
permanent  restoration  is  very  promising  in  most  cases.  How 
far  alcoholic  trance  exists  in  criminal  cases  is  unknown,  but 
the  time  has  come  when  such  a  claim  by  criminals  cannot 
be  ignored,  and  must  be  the  subject  of  serious  inquiry.  Such 
a  claim  cannot  be  treated  as  a  mere  subterfuge  to  avoid 
punishment,  but  should  receive  the  same  attention  that  a 
claim  of  insanity  or  self-defense  would.  This  is  only  an 
outline  view  of  a  very  wide  and  most  practical  field  of 
medico-legal  research,  largely  unknown,  which  can  be  seen 
in  every  court-room  of  the  land.  These  cases  appeal  to  us 
for  help  and  recognition,  and  the  highest  dictates  of 
humanity  and  justice  demand  of  us  an  accurate  study  and 
comprehension  of  their  nature  and  character. 

The  following  summary  of  the  leading  facts  in  this 
trance  condition  will  be  a  standpoint  for  other  and  more 
minute  investigations  : 

ist.  The  trance  state  in  inebriety  is  a  distinct  brain  con- 
dition, that  exists  beyond  all  question  or  doubt. 

2d.  This  brain  state  is  one  in  which  all  memory  and 
consciousness  of  acts  or   words   are   suspended,  the  person 


SOME   FOKMS   OF   IKKESPONSIBILITT.  307 

going  about  automatically,  giving  little  or  no  evidence  of 
his  real  condition. 

3d.  The  higher  brain  centers  controlling  consciousness 
are  suspended,  as  in  the  somnambulistic  or  hypnotic  state. 
The  duration  of  this  state  may  be  from  a  few  moments  to 
several  days,  and  the  person  at  this  time  may  appear  con- 
scious and  act  naturally,  and  along  the  line  of  his  ordinary 
life. 

4th,  During  this  trance  period  crime  against  person  or 
property  may  be  committed  without  any  motive  or  appar- 
ent plan,  usually  unforseen  and  unexpected.  When  accu- 
rately studied  such  a  crime  will  lack  in  the  details  and 
methods  of  execution,  and  also  show  want  of  consciousness 
of  the  nature  and  results  of  such  acts. 

5th.  When  this  condition  passes  away  the  acts  and  con- 
duct of  the  person  show  that  he  did  not  remember  what  he 
had  done  before.  Hence  his  denial  of  all  recollection  of 
past  events  and  his  changed  manner  confirm  or  deny  his 
statements. 

6th.  When  such  cases  come  under  judicial  inquiry  the 
statement  of  the  prisoner  requires  a  scientific  study  before 
it  can  he  accepted  as  a  probable  fact.  It  cannot  be  simu- 
lated, but  is  susceptible  of  proof  beyond  the  comprehension 
of  the  prisoner. 

7th.  In  such  a  state  crime  and  criminal  impulses  are 
the  result  of  unknown  and  unforeseen  influences,  and  the 
person  in  this  condition  is  dangerous  and  an  irresponsible 
madman. 

8th.  This  condition  should  be  fully  recognized  by  court 
and  jury,  and  the  measure  of  responsibility  and  punishment 
suited  to  each  case.  They  should  not  be  punished  as  crim- 
inals, nor  should  they  be  liberated  as  sane  men.  They 
should  be  housed  and  confined  in  hospitals. 


CHAPTER  XXX. 

PRACTICAL  DIFFERENTIATION   OF   INEBRIETY    FROM 
COMA,   ETC.,  ETC. 

The  frequent  occurrence  of  blunders  in  mistaking  brain- 
diseases  for  drunkenness,  and  the  serious  reproach  they 
bring  on  medical  men,  render  it  necessary  that  more  earnest 
attention  siiould  be  paid  to  the  subject  than  heretofore,  and 
that  a  higher  knowledge  should  be  obtained  of  the  charac- 
ter of  the  dangers  incident  to  these  accidents.  Unfortu- 
nately, drunkenness  has  not,  save  in  a  few  instances,  been 
studied  as  a  disease,  and  consequently  the  manifestations 
pertaining  to  it  are  very  little  understood.  The  ignorance 
is  particularly  unfortunate  when  it  is  necessary  to  distin- 
guish between  it  and  brain-troubles. 

In  starting  out  in  this  discussion,  our  first  duty  will  be 
to  enumerate  the  different  conditions  which  may  be  mistaken 
for  drunkenness,  and  the  symptoms  of  which  it  is  necessary 
to  bear  in  mind  in  forming  a  diagnosis. 

These  are  : 

1.  Fracture  of  the  skull. 

2.  Concussion  of  the  brain. 

3.  Cerebral  hemorrhage. 

4.  Embolism  and  thrombosis. 

5.  Uraemia,  from  Bright's  disease. 

6.  Epilepsy. 

7.  Narcotic  poisoning. 

8.  Heat  apoplexy. 

We  will  take  up  these  lesions  one  by  one. 

In  cases  of  fracture  of  the  skull,  or  where  severe  or  stun- 

309 


310  DISEASES    OF   INEBRIETY. 

ning  blows  have  been  dealt,  the  greatest  difficulty  is  met 
with  in  the  diagnosis  in  the  absence  of  any  history  of  the 
case,  for  the  reason  that  the  coma  in  these  instances  is 
frequently  profound,  and  simulates  that  of  drunkenness. 
The  smell  of  the  breath  should  never  be  relied  on  as  a  test, 
for  many  industrious  and  useful  workmen  are  in  the  habit 
of  taking  a  certain  amount  of  liquor  during  the  day. 

The  temperature,  the  condition  of  the  pupils,  the  breath- 
ing, should  all  be  carefully  observed,  but  the  true  rule  is  to 
keep  the  patient  under  close  and  constant  watch,  until  a 
fixed  diagnosis  is  obtained.  It  is  also  important,  in  these 
cases,  to  look  closely  for  wounds  and  marks  of  violence. 

Mr.  Lavvson,  of  Middlesex  Hospital,  relates  an  interest- 
ing case  bearing  on  this  point.  "  The  patient  was  taken  to 
the  police-cell  as  drunk.  He  was  medically  examined,  and 
recovered  sufficiently  from  his  apparent  drunken  semi-con- 
sciousness to  be  able  to  converse  with  those  about  him. 
After  a  few  hours,  however,  severe  cerebral  symptoms  came 
on,  and  he  was  transferred  to  the  hospital,  where  he  died  on 
the  thirteenth  day  from  severe  lacerations  of  the  brain-sub- 
stances, associated  with  extensive  hemorrhage,  and  with 
fracture  into  the  lamboidal  suture,  A  remarkable  point  in 
this  case  was  the  absence  of  paralytic  symptoms,  considering 
the  severe  laceration  of  the  brain.  With  the  exception  of  the 
loss  of  power  over  the  sphincters,  there  was  no  paralysis 
whatever," 

Cerebral  hemorrhage  is  more  frequently  mistaken  for 
drunkenness  than  any  other  trouble,  for  the  reason  that  the 
symptoms  are  similar  in  several  stages  of  the  two  diseases. 
There  is  a  stage  of  noisy  violence  and  uproar  in  both,  and 
also  a  condition  of  complete  coma.  In  ordinary  cases  of 
apoplexy  we  look  for  paralysis  of  one  side  or  the  other,  but 
this  does  not  always  obtain,  if  the  hemorrhage  be  into  the 
pons,  or  lateral  ventricle.  We  may  have  convulsions  in  both 
diseases,  but  usually  they  are  more  severe  on  one  side  of  the 
body  in  apoplexy. 


INEBKIETY    FROM   COMA.  311 

The  State  of  the  pupils  cannot  always  be  relied  on  as  a 
differential  test,  although  squinting  as  well  as  conjugate 
deviation  of  the  eyes  is  a  distinctive  mark  of  apoplexy. 
Doctor  MacEwen,  of  Glasgow,  says  the  ordinary  opinion  that 
dilation  of  tiie  pupils  is  found  in  alcoholic  coma  is  incorrect, 
but  that  contraction  is  the  rule.  He  accidentally  discov- 
ered, however,  that  if  a  patient  was  sliaken  or  disturbed,  the 
pupils  dilated,  but  very  soon  contracted  again.  He  there- 
fore lays  down  the  rule  that  an  insensible  person  who, 
being  left  undisturbed  for  from  ten  to  thirty  minutes,  has 
contracted  pupils,  which  dilate  on  his  being  shaken,  without 
any  return  of  consciousness,  and  then  contract  again,  can 
be  laboring  under  no  other  state  than  alcoholic  coma. 
Strange  to  say.  Dr.  Reynolds  has  witnessed  the  same  phe- 
nomena in  patients  suffering  from  acute  softening.  He  says 
in  his  system  of  medicine,  that  he  has  often  raised  the  lids 
of  patients  in  this  condition,  and  exposed  the  contracted 
pupils  to  the  light  without  arousing  them  ;  that  there  is  no 
dilation  or  change  to  be  observed,  but  if  they  be  addressed 
loudly  by  name,  or  their  toes  pinched  so  that  they  awake,  the 
pupils  instantly  dilate. 

The  truth  is,  that  in  cerebral  hemorrhage  the  pupils  pre- 
sent no  fixed  peculiarity.  There  may  be  a  clot  on  one  side 
of  the  brain,  and  yet  the  pupils  appear  normal.  Their  con- 
dition may  even  vary  in  different  cases  of  the  same  lesion. 
Cases  of  ingravescent  apoplexy  generally  commence  with 
delirium  or  convulsion,  and  the  coma  comes  on  slowly  and 
gradually.  These  are  the  cases  that  are  frequently  mis- 
taken for  drunkenness,  provided  the  smell  of  alcohol  be  dis- 
covered on  the  breath  of  the  patient. 

Cases  of  embolism  and  thrombosis  should  not  be  con- 
founded witli  drunkenness.  In  embolism,  the  coma  is  sud- 
den and  transient,  and  in  thrombosis,  the  paralytic  symp- 
toms are  so  marked  that  an  error  can  scarcely  occur.  Fatal 
cases  of  sudden  coma  and  paralysis,  with  partial  recovery 


312  DISEASES   OF   INEBRIETY. 

of  consciousness  and  power,  are  met  with,  independent  of 
drunkenness  or  brain  trouble. 

A  remarkable  case  of  this  character  is  reported  in  the 
Lancet^  in  which  the  only  lesion  found  after  death  was 
liydatids  of  the  pineal  gland,  liver  and  peritoneum.  The 
patient  died  in  thirteen  hours  from  the  commencement  of 
the  attack.  In  cases  of  coma  from  uraemia,  the  diagnosis  is 
not  so  difficult,  inasmuch  as  we  have  some  well-marked 
points  for  our  guidance.  This  form  of  coma  is  generally 
preceded  by  convulsions.  The  breath  has  a  peculiar  un- 
mistakable fetor,  and  the  urine  upon  examination  will  be 
found  to  contain  a  large  quantity  of  albumen  as  well  as 
other  deposits,  indicating  kidney  disease.  Occasionally, 
however,  cerebral  hemorrhage  is  present  along  with  uraemic 
poisoning,  and  this  complicates  to  some  extent  the  diagnosis. 

Another  difficulty  in  diagnosis  in  that  the  urine  may 
become  temporarily  albumenous  from  the  inordinate  use  of 
alcohol.  Dr.  George  Johnson  mentions  a  case  of  this  char- 
acter, which  occurred  in  the  practice  of  his  friend  Dr.  Baxter. 
**  A  man  between  twenty  and  thirty  years  of  age  was  brought 
in  one  night  by  the  police.  He  was  unconscious  and  breath- 
ing stertorously.  He  appeared  to  be  drunk,  aud  a  large 
quantity  of  vinous  liquid  was  pumped  out  of  his  stomach. 
The  unconsciousness  continued,  and  it  was  then  suspected 
tliat  he  might  be  suffering  from  uraemic  poisoning.  This 
suspicion  was  confirmed  by  the  fact  that  his  urine,  drawn 
off  by  a  catheter,  was  loaded  with  albumen.  He  was  then 
put  to  bed,  cupped  over  the  loins,  and  a  purgative  was  given. 
When  Dr.  Baxter  visited  the  ward  next  morning,  he  found 
the  man  up  and  dressed,  and  clamoring  for  his  discharge. 
He  said  he  had  been  very  drunk  over  night,  but  now  he 
had  nothing  the  matter  with  him  ;  and  he  passed  some 
Urine,  which  was  found  to  be  in  every  respect  quite  normal. 
The  temporary  albuminuria  was  the  result  of  renal  conges- 
tion, caused  by  the  excretion  of  an  excess  of  alcohol  through 
the  kidneys." 


INEBRIETY   FROM   COMA.  313 

Epilepsy  can  generally  be  diagnosed  without  much 
difficulty,  though  if  the  patient  is  not  seen  during  the 
attack,  but  only  during  the  profound  and  prolonged  coma 
which  sometimes  follows  the  paroxysm,  the  case  may  be 
mistaken  for  one  of  drunkenness.  Epileptic  coma,  how- 
ever, is  usually  of  short  duration,  and  if  the  tongue  is  bitten 
or  bleeding,  or  if  hemorrhagic  spots  be  discovered  beneath 
the  conjunction  or  skin,  all  uncertainty  with  regard  to  the 
case  will  be  cleared  up. 

The  coma  resulting  from  the  poisoning  by  opium  is  very 
similar  to  that  produced  by  the  administration  of  large 
quantities  of  alcohol.  At  one  time  it  was  believed  that 
extreme  contraction  of  the  pupils  was  a  distinguishing  mark 
of  coma  resulting  from  opium,  but  this,  it  is  known,  cannot 
be  relied  on,  inasmuch  as  the  pupils  are  often  found  con- 
tracted, as  I  have  before  mentioned,  in  alcoholism,  and  also, 
as  mentioned  by  Dr,  Wilks,  in  apoplexy  seated  in  the  pons 
varolii.  In  cases  of  opium  poison  that  I  have  seen,  I  have 
always  thought  that  the  breathing  was  much  slower  than  in 
the  coma  produced  by  drunkenness,  but  in  this  I  may  be 
mistaken.  The  smell  of  opium  is  frequently  to  be  dis- 
covered on  the  breath,  particularly  if  laudanum  has  been 
taken,  and  this  becomes  an  important  feature,  provided  no 
history  of  the  case  can  be  obtained. 

There  are  many  symptoms  in  severe  cases  of  heat  apo- 
plexy which  might  mislead  an  inexperienced  practitioner, 
and  cause  him  to  believe  his  patient  is  suffering  from  the 
effects  of  drunkenness.  Coma  is  very  often  the  result  of 
sunstroke,  and  great  mental  disturbance  and  outward  vio- 
lence are  not  unfrequent  results  of  aggravated  cases.  I  can 
remember  several  instances  in  which  I  was  in  doubt  for  a 
time  in  regard  to  the  origin  of  the  symptoms  present  in 
cases  which  afterwards  proved  to  be  heat  apoplexy.  There 
is  one  very  simple  diagnostic  mark  in  sunstroke  which  is 
never  absent,  and  which  will  greatly  aid  us  in  forming  a 
judgment :  it  is  intense  heat  of  the  head — a  heat  which  is 


314  DISEASES    OF   INEBRIETY. 

to  be  found  in  no  other  disease,  save  yellow  fever.  In  the 
coma  of  drunkenness  this  extreme  heat  is  never  found — at 
least,  I  have  not  met  it  in  my  own  experience. 

I  have  seen  many  cases  of  hysteria  in  women  which  at 
first  puzzled  me,  inasmuch  as  the  symptoms  were  similar  to 
those  induced  by  the  action  of  alcohol.  These  cases  are 
not  so  much  characterized  by  coma  as  by  a  state  of  excite- 
ment and  violent  demonstration.  The  phases  of  hysteria 
are  so  varied,  and  the  abnormal  manifestations  of  this 
trouble  so  curious,  that  the  ordinary  practitioner  may  read- 
ily mistake  neurotic  trouble  for  the  effects  of  alcohol  ;  as,  on 
the  contrary,  he  may  and  does  frequently  mistake  drunken- 
ness for  hysteria.  The  puzzling  cases  I  have  met  with  are 
those  in  which  there  was  a  combination  of  whiskey  and 
hysteria,  a  condition  which,  I  may  add,  is  of  the  most 
delightful  character,  and  affording  a  train  of  the  most 
original  and  beautiful  manifestations.  The  methods  of 
examination  in  coma  may  be  summarized  as  follows  : 

First.  An  examination  of  the  head  and  body  for  frac- 
ture of  the  skull  and  external  injuries. 

Second.  Examination  for  hemiplegia,  squinting,  conju- 
gate deviation  or  facial  paralysis. 

Third.     Examination  of  the  mouth  and  tongue. 

Fourth,  The  legs  and  eyelids  should  be  examined  to 
see  if  oedema  had  previously  existed. 

Fifth.  An  examination  of  the  urine  both  for  albumen 
and  alcohol. 

Sixth.  A  stomach  pump  may  be  used  in  many  cases 
with  great  advantage. 

Seventh.  A  history  of  the  attack  and  its  general  features 
should  be  inquired  into,  if  possible. 

Eighth.  The  pupils  and  breath  should  both  be  examined 
and  the  temperature  taken,  thougli  undue  importance,  as 
before  stated,  should  not  be  attached  to  the  evidences 
afforded  by  such  an  examination. 

In  conclusion,  let  me  particularly  dwell  on  the  import- 


INEBRIETY    FROM   COMA.  315 

ance  of  close  attention  and  watchfulness  in  all  cases  of 
coma  supposed  to  be  due  to  drunkenness.  The  system 
heretofore  pursued  has  been  most  barbarous,  both  in  this 
country  and  Europe,  and  is  a  reproach  to  our  civilization. 
Dwelling  on  this  subject,  Dr.  John  Curnow  pointedly  says  : 
"  I  must  enter  a  protest  against  the  routine  treatment  of 
drunkenness  too  generally  followed,  viz.:  emetics  or  the 
stomach  pump,  cold  effusion,  flecking  the  skin  with  a  wet 
towel,  and  then  the  interrupted  galvanic  current.  A  patient 
having  grumbled  out  a  name,  and  perhaps  an  address,  is 
turned  over  to  a  policeman,  who  speedily  consigns  him  to  a 
cold  cell  to  sleep  off  his  symptoms.  It  cannot  too  often  be 
insisted  upon  that  a  drunken  man  is  suffering  from  acute 
poison,  and  cannot  be  too  closely  watched." 

All  police  stations  should  have  a  regularly  appointed 
medical  officer  in  charge,  and  every  case  of  sickness,  or 
aggravated  case  of  drunkenness,  should  be  put  under  his 
care.  Certain  instruments  and  appliances  should  be  con- 
stantly at  hand,  and  supplied  at  public  expense,  such  as  a 
stomach  pump,  galvanic  battery,  hypodermic  syringe,  test 
tubes,  cupping  apparatus,  as  well  as  mustard,  apomorphia, 
etc.  When  these  precautions  are  taken,  and  when  inebriety 
is  added  to  the  list  of  diseases,  and  its  treatment  taught  in 
our  schools,  many  lives  will  be  saved  and  much  unhappiness 
be  spared  to  the  community. 


CHAPTER  XXXI. 

GENERAL  CONSIDERATIONS  OF  OPIUM  INEBRIETY. 

Opium  neurosis  is  not  an  intoxication  from  the  drug, 
but  a  central  neurotic  change,  brought  about  by  the  long 
persisting  perversion  of  function  and  impairment  of  cen- 
tral nervous  nutrition,  from  its  persisting  presence  in  the 
nutrient  pabulum  of  the  circulation. 

The  psychosis  of  opium  is  a  blended  intoxication  and 
chronic  poisoning  of  the  psychical  centers  of  the  brain  ; 
other  symptoms  of  acute  opium  poisoning  are  essentially 
different,  being  mainly  a  profound  paralysis  of  sensation 
and  of  the  centers  of  involuntary  motion  especially  having 
their  origin  in  the  medulla  and  upper  part  of  the  spinal 
cord — profound  narcosis,  lowered  respiratory  movements, 
etc.,  while  chronic  opium  poisoning,  or  meconeuropathia,  is 
characterized  by  repeated  nerve  excitations,  in  which  the 
nerve  centers,  not  being  completely  overcome,  a  kind  of 
tolerance  is  established,  with  progressively  developing 
abnormal  molecular  neural  changes,  which  are  as  repeat- 
edly covered  up  and  masked  by  the  renewed  doses,  till 
some  sudden  deprivation  of  the  drug  or  failure  to  appropri- 
ate it,  reveals,  in  full  force,  the  neural  mischief  which  has 
been  gradually  done.  Opium,  like  a  bank  defaulter,  both 
makes  and  masks  the  mischief  done,  which  may  be  kept 
concealed  so  long  as  he  stays  in  the  institution. 

Beyond  all  question,  the  toxic  use  of  opium  and  its  alka- 
loids is  rapidly  increasing.  Only  about  50  per  cent,  of 
opium  and  morphine  manufactured  is  required  by  the  legit- 
imate demands  of  medicine  and  pharmacy.     The  enormous 

317 


318  DISEASES    OP   INEBRIETY. 

balance  is  consumed  in  some  unknown  way.  Comparative 
estimates  make  the  number  of  opium  cases  in  this  country 
over  a  hundred  tliousand.  Wlietlier  tliis  is  correct  or  not, 
it  is  evident  that  the  number  is  very  great  and  largely  con- 
cealed, and  many  of  them  are  very  hopeless  and  difficult  to 
treat.  The  natural  history  of  such  cases  indicates  a  steady, 
progressive  degeneration  on  to  death.  Recovery  is  rarely 
spontaneous  and  without  tlie  aid  of  applied  science. 

The  central  tracts  involved  are  the  cerebro-spinal  and 
sympathetic  systems.  Deviations  from  health  noted  are 
due  to  departure  from  the  normal  tone  of  one  or  both  of 
these  centers.  Organic  lesions  are  rare,  possibly  some 
instances  of  renal  or  brain  disease,  the  usual  ultimate  result 
being  a  state  of  marasmus,  impaired  nutrition  and  profaned 
nerve  depression  ending  in  death. 

From  a  careful  clinical  study  and  grouping  of  the  his- 
tory of  a  number  of  opium  cases,  it  is  evident  that  a  large 
proportion  have  a  distinct  neurotic  diathesis,  or,  more  literally, 
have  inherited  from  their  parents  some  condition  of  brain 
and  nerve  defect  which  favors  and  predisposes  to  the  devel- 
opment of  neurotic  diseases.  A  more  careful  study  of  these 
records  shows  that  in  some  cases  an  opium  diathesis  is  present, 
or  a  special  inherited  tendency  to  use  opium.  Here  are 
two  conditions  which  influence  and  favor  this  disease.  It 
is  a  well-known  fact  that  a  large  proportion  of  all  nerve 
and  brain  diseases  appears  in  children  of  neurotic  and 
defective  parents.  Such  children  have  received  some  special 
tendency  and  predisposition  favoring  the  growth  of  nerve 
diseases,  springing  into  activity  from  the  slightest  causes. 

The  latency  or  activity  of  this  diathesis  will  depend  on 
certain  conditions  of  life  and  surroundings,  which  in  many 
cases  can  be  traced.  In  some  instances  the  diseases  of 
parents  reappear  in  the  children,  in  others  in  allied  diseases, 
and  not  infrequently  these  defects  pass  over  and  reappear 
in  the  third  generation.  Often  such  defects  are  dormant, 
and  onl}'  break  out  from  the  application  of  some  peculiar 


GENERAL   CONSIDERATIONS    OF   OPIUM   INEBRIETY.        319 

exciting  cause.  Thus  a  hysteric  mother  and  paranoic 
father  were  followed  by  three  children.  One  was  an  alco- 
holic, the  second  was  a  wild,  impulsive  temperance  reformer, 
the  third  was  a  sad,  depressed,  melancholic  man.  In  the 
third  generation  opium  and  alcoholic  inebriety,  insanity, 
pauperism,  also  feebleness  of  mind  and  body,  appeared. 
These  varied  forms  of  nerve  diseases  all  had  a  neurotic 
diathesis  as  a  basis,  and  the  different  phases  were  the  direct 
result  of  different  exciting  causes.  These  facts  are  numer- 
ous and  well  attested,  and  so  uniform  in  their  operation  that 
it  is  entirely  within  the  realm  of  possibility  to  predict  that, 
from  a  knowledge  of  the  diseases  of  the  parents  and  the 
environment  of  the  child,  certain  forms  of  degeneration  and 
diseases  w^ill  appear  with  almost  astronomical  precision. 
This  term,  "  neurotic  diathesis,"  covers  a  vast  unknown  field 
of  causes  which  extend  back  many  generations. 

The  evolution  of  brain  and  nei/^  defects  can  often  be 
traced  through  the  realms  of  environment,  nutrition,  growth, 
and  development.  Medical  text-books  and  teaching  which 
fail  to  recognize  this,  give  very  narrow  conceptions  and 
strange  exaggeration  of  the  influence  and  force  of  many 
insignificant  and  secondary  factors  in  the  production  of  dis- 
ease. The  opium-taker  has  often  this  neurotic  element  in 
his  history.  It  may  be  traced  back  to  his  ancestors,  or  it 
may  be  associated  with  brain  or  nerve  injuries,  cell-starvation, 
faulty  nutrition,  auto-intoxications,  brain  strains,  or  exces- 
sive drains  of  nerve  force.  A  train  of  predisposing  causes 
may  have  been  gathering  for  an  indefinite  time  back.  Then 
comes  the  match  which  kindles  or  fires  the  train  oi  gathering 
forces.  This  same  train  of  exciting  causes  may  not  explode, 
because  the  germ  soil  is  absent.  Opium  in  all  forms  is 
given  daily,  and  yet  only  a  comparatively  small  number  of 
cases  become  addicted  to  its  use.  Why  should  an  increas- 
ing number  of  persons  take  opium  continuously  for  the  tran- 
sient relief  it  gives  ?  Why  should  the  effects  of  this  drug 
become  so  pleasing  as  to  demand  its  increased  use,  irrespect- 


320  DISEASES    OF   INEBRIETY. 

ive  of  all  consequences  ?     The  only  explanation   is  the  pres- 
ence of  a  neurotic  diathesis,  either  inherited  or  acquired. 

There  is  a  large  class  of  opium  cases  in  which  a  complex 
diathesis  exists — particularly  following  inebriety  and  var- 
ious forms  of  brain  exhaustion  Often  alcoholics  will  use 
opium  irregularly  and  transmit  to  their  descendants  a 
diathesis  which  very  commonly  favors  the  use  of  this  drug. 
Thus  the  alcohol  diathesis  frequently  becomes  the  opium 
craze,  with  but  slight  exposure.  Both  of  these  disorders 
are  rapidly  interchangeable.  The  children  of  opium  takers 
may  turn  to  alcohol  for  relief,  and  vice  versa.  It  is  clear 
that  the  moderate  use  of  alcohol  produces  a  degree  of 
degeneration  that  frequently  appears  in  the  next  generation 
as  predisposing  causes  to  the  opium  or  allied  diseases. 
Clinical  study  of  cases  brings  ample  confirmation  of  this. 
The  children  of  both  alcohol  and  opium  inebriates  display 
many  forms  of  brain  degeneration.  Tlie  paranoics,  criminals, 
prostitutes,  paupers,  and  the  army  of  defects,  all  build  up  a 
diathesis  and  favoring  soil  for  the  opium  craze.  Descend- 
ants from  such  parents  will  always  be  markedly  defective. 
They  are  noted  b)''  brain  and  nerve  instability,  hyperaesthesia, 
and  tendency  to  exhaustion  ;  also  extreme  pain  from  every 
degree  of  functional  disturbance,  with  low  powers  of  restor- 
ation, inability  to  bear  pain,  and  suffering  from  mental 
changeability,  impulsiveness  and  drug  credulity,  etc. 

Tiiese  characteristics  are  prominent,  and  mark  a  neuro- 
sis that  quickly  merges  into  the  opium  disease.  Yet  a  min- 
ority of  these  cases  show  a  sensitiveness  in  the  effects  of 
opium  that  prevents  them  from  using  it.  I  have  seen  a 
neurotic  patient  become  dangerously  narcotized  by  the  use 
of  half  a  grain  of  solid  opium.  Some  of  the  alcoholics  and 
other  narcomaniacs  have  exhibited  an  incompatibility  to 
opium  that  is  often  startling.  The  emesis  and  prostration, 
and  the  brain  stimulation  which  approaches  and  becomes 
hyperaemia  from  one  or  more  doses,  are  familiar  to  all. 
This  intolerance  precludes  the  use  of  the  drug,  and  is  recog- 


GENERAL   CONSIDEKATIONS    OF   OPIUM    INEBRIETY.        321 

nized  with  alarm  by  the  patient.  On  the  other  hand,  when 
the  effects  are  rapid  and  marked,  relieving  pain  or  restoring 
the  disturbance  of  the  functions,  with  no  other  than  a  pleas- 
ing sense  of  rest  and  cure,  a  dangerous  diathesis  should  be 
suspected.  While  the  physician  recognizes  the  constitu- 
tional incompatibility  in  one  case,  he  ought  not  to  overlook 
the  abnormal  attractiveness  of  the  drug  in  the  other.  The 
dose  of  morphine  which  gives  the  first  complete  rest,  or 
calms  the  delirious  excitement,  or  relieves  the  neuralgic 
pain  or  the  digestive  disturbance,  soon  calls  for  its  repeti- 
tion, and  many  physicians  will  unconsciously  sanction  and 
advise  its  use.  Thus,  far  more  fatal  conditions  are  culti- 
vated and  roused  into  activity. 

In  all  neurotic  cases,  the  use  of  opium  in  any  form  when 
given,  should  be  concealed  and  watched  with  care.  If  a 
special  predilection  for  this  drug  appears,  equal  care  and 
skill  should  be  exercised  to  divert  and  change  it.  Opium 
should  only  be  used  from  a  knowledge  of  the  nature  and 
cliaracter  of  the  case.  I  have  seen  the  most  disastrous 
results  from  the  reckless  use  of  morphine  with  the  needle. 
Recently,  a  man  to  whom  morphine  was  intolerant  was  cut 
and  stunned  by  a  falling  plank  in  the  street.  The  surgeon 
gave  him  a  hypodermic  of  morphine  and  ordered  him  to  the 
hospital.  He  died  in  a  short  time  from  opium  neuroses. 
Police  surgeons  often  make  this  mistake,  giving  morpliine 
that  from  some  unknown  reason  becomes  fatal. 

There  is  another  class  of  opium  takers  in  which  abnor- 
mal nutrition  seems  to  be  the  most  active  factor  in  the  cau- 
sation. The  neurotic  or  opium  diathesis  is  not  apparently 
present,  and  opium-taking  dates  from  some  nutrient  disturb- 
ance. Such  cases  are  very  commonly  sufferers  from  dyspep- 
sia, derangement  of  the  liver  and  bowels.  They  have  a 
deranged  appetite,  headaches,  cramps,  thirst,  and  fever  at 
times,  with  nausea.  Tiiey  are  anaemic  and  hypersesthetic 
and  complain  of  varied  pains  and  neuralgia.  These  cases 
are  evidently  ill-nourished,  and,  in  all  probability,  suffer  from 


322  DISEASES   OF    INEBRIETY. 

imperfect  digestion,  assimilation,  and  elimination  of  food- 
products  and  waste  material.  Poisonous  compounds  and 
auto-intoxications  form  sources  of  serious  trouble.  The 
brain  suffers  from  fatigue  and  pain,  the  cells  are  imperfectly 
nourished,  and  congestions,  complex  neuralgias,  nerve  irri- 
tation and  instability  follow.  For  this  condition  opium  is 
almost  a  specific  paralyzant.  These  cases  are  found  among 
the  over-fed,  the  under-fed,  and  those  who  neglect  common 
hygienic  rules  of  living. 

Cases  of  the  over-fed  are  usually  epicures,  gormands, 
and  persons  living  sedentary  lives,  and  eating  at  all  times 
and  places.  Dyspepsia  and  derangement  of  the  bowels  and 
kidneys  make  tiiem  drug-takers;  then  follows  opium  in  some 
form.  Defective  elimination  and  auto-intoxications  are 
always  present.  Tiie  under-fed  are  usually  misers,  or  persons 
very  poor  and  very  neglectful  of  themselves,  or  paranoics 
who  have  some  food  delusion.  They  are  practically  suffer- 
ing from  cell  and  tissue  starvation  and  nutrient  debility. 
The  same  dyspepsia  and  bowel  derangements  follow.  Then 
follows  drug-taking  or  special  foods,  and  soon  opium  is  dis- 
covered and  adopted  as  a  remedy.  The  same  poisonous 
waste  products  appear  from  deranged  assimilation;  also, 
elimination  and  the  nerve  centers  are  deranged  by  these 
new  and  dangerous  chemical  compounds.  The  class  of 
persons  who,  from  simple  neglect,  become  diseased,  are  often 
the  very  poor  and  ignorant,  or  some  division  of  the  great 
army  of  border-liners,  who  live  both  mentally  and  physically 
on  the  very  frontiers  of  sanity  and  insanity.  Such  persons 
clearly  suffer  from  many  and  various  forms  of  auto-intoxi- 
cations, and  this  is  proven  inductively  by  the  result  of 
eliminative  treatment. 

In  all  of  these  cases  of  nutrient  neglect,  many  favoring 
conditions  encourage  the  use  of  opium.  These  cases  are 
numerous  and  comprise  a  large  part  of  the  invalids, 
hypochondriacs,  and  chronic  drug-takers,  who  are  seen  in 
our  offices  and  at  the  dispensaries.     They  are  all  practically 


GENERAL   CONSIDERATIONS   OF   OPIUM   INEBRIETY.        323 

suffering  from  faulty  assimilations,  and  faulty  eliminations 
and  the  irritation  of  retained  poisonous  compounds.  Opium 
is. a  remedy  of  positive  force  in  covering  up  the  protests  of 
the  defective  cells  and  irritable  nerves.  Often  these  cases 
are  concealed,  and  are  partly  the  result  of  previous  disorder, 
and  partially  acquired  from  tiie  effects  of  opium. 

Next  to  this  class  of  nutrient  sufferers  who  become  opium- 
takers,  are  those  who  have  some  entailment  of  disease  or 
injury.  In  their  history  it  will  appear  that  some  stage  of 
invalidism  was  present,  dating  from  brain,  nerve,  or  bodily 
injury.  Fevers,  heat,  or  sun-strokes,  brain  shocks  from  any 
source,  which  are  followed  by  unconsciousness  or  marked 
mental  perturbations,  with  exhaustion,  and  also  a  profound 
lowering  of  all  the  vital  forces.  These  and  other  events  have 
left  damaged  functional  and  organic  activities,  manifest  in 
various  neuralgias  and  physical  disturbances. 

The  use  of  opium  conceals  and  covers  up  this  trouble. 
Many  veterans  of  the  late  war  have  become  opium  maniacs 
for  the  relief  of  their  pains  and  sufferings,  and  this  is  often 
concealed  where  it  might  possibly  peril  the  procuring  of  a. 
pension.  The  pension  bureau  should  recognize  the  use  of 
opium  as  a  natural  sequence  and  entailment  following  the 
disease  and  injury  in  the  service.  In  Prussia,  both  alcohol 
and  opium  inebriety  are  treated  as  diseases  when  occurring 
in  the  army  or  civil  service.  The  suffering  and  hardships 
growing  out  of  the  war  has  been  the  exciting  cause  of  a 
great  many  opium  cases.  Many  persons  who  have  no  spec- 
ial nerve  diathesis  in  their  history,  after  some  severe  illness, 
injury,  or  mental  strain,  exhibit  a  degree  of  nerve  instability 
and  feebleness  that  is  significant  of  serious  organic  change. 
Such  persons  manifest  perversions  of  taste,  with  delusions 
of  food  and  medicines,  and  are  on  the  border-lines  of  nar- 
comania, ready  to  use  any  food  or  drugs  which  will  bring 
even  transient  relief. 

The  use  of  opium  is  always  perilous.     Why  all  these  and 


324  DISEASES   OF    INEBRIETY. 

similar  cases  do  not  become  opium-takers  is  owing  to  the 
absence  of  some  diathesis  inherited  or  acquired. 

We  can  see  some  of  the  many  complex  causes  favoring 
brain  and  nerve  strain,  with  rapid  exhaustion  and  degener- 
ation, and  the  interchangeability  of  nerve  diseases,  in  which 
tlie  use  of  opium  is  only  another  form  of  the  same  disease. 
But  we  cannot  yet  trace  the  early  causes  and  cell-conditions 
which  develop  the  opium  craze.  This  morbid  impulse,  like 
the  delirious  thirst  for  water  on  a  desert  plain  completely 
dominates  all  reason  and  so-called  will-power,  and  every 
consideration  of  life  and  surroundings.  It  is  more  than  an 
accident,  more  than  a  failure  to  reason  and  act  wisely  ;  it  is 
a  disease,  an  organized  march  of  dissolution.  The  demand 
for  opium  is  only  a  symptom  ;  the  removal  of  opium  is  not 
the  cure.  Some  central  brain  degeneration  has  begun  and 
is  going  on.  Narcomania,  a  morbid  thirst  for  any  solids  or 
fluids  that  will  produce  neuroses,  is  the  general  name,  and 
opium  mania  is  only  one  member  of  this  family. 

In  this  study  the  fact  is  emphasized  that  the  opium 
disease  appears  most  frequently  in  persons  who  have  a 
neurotic  and  opium  diathesis,  and  also  in  persons  who  are 
suffering  from  nutrient  disturbances,  and  those  who  are 
invalids  or  have  some  entailment  of  previous  disease  and 
injury  ;  also  that  certain  diseases  and  symptoms  seem  to 
furnish  favoring  soils  for  its  growth  and  development. 
While  these  are  but  faint  outlines  of  many  unknown  facts, 
they  are  urged  as  starting  points  from  which  to  base  other 
and  more  accurate  studies.  The  medical  treatment  from 
this  point  of  view  is  very  suggestive.  Obviously  the  removal 
of  the  opium  is  not  the  cure.  The  various  methods  of 
removal,  detailed  with  great  exactness,  as  if  they  would 
apply  to  each  case,  are  unfortunate  reflections  of  the  fail- 
ure of  the  writers,  and  are  based  on  tlie  assumption  that  all 
cases  are  the  same,  and  the  removal  of  opium  is  the  great 
essential  in  the  treatment. 

Basing  the  treatment  on  the  clinical  study  of  the  case,  it 


GENERAL   CONSIDERATIONS    OF   OPIUM   INEBRIETY.        325 

will  be  evident  that  where  an  opium  diathesis  exists,  the 
withdrawal  of  opium  should  be  very  gradual.  The  treat- 
ment and  surroundings  should  be  arranged  with  great  care 
and  exactness.  Such  persons  should  live  in  an  institution 
for  a  long  time,  or  be  under  constant  medical  care.  The 
danger  of  relapse  and  the  future  of  such  cases  will  depend 
entirely  on  the  conditions  of  life  and  surroundings.  Rapid 
reduction  and  any  heroic  treatment  is  never  permanent, 
even  with  the  consent  of  the  patient.  Specific,  faith  cures, 
or  any  measures  that  promise  speedy  cure,  are  failures 
from  the  beginning.  The  road  back  to  approximate  health 
is  straight  and  narrow,  and  only  along  lines  of  applied 
science.  Where  the  history  of  a  neurotic  diathesis  is  present, 
the  withdrawal  of  tiie  opium  should  be  equally  slow. 

More  attention  must  be  paid  to  the  brain  and  nerve 
nutrition.  The  removal  of  opium  may  be  followed  by  the 
appearance  of  very  serious  disorders,  such  as  epilepsy, 
hysteria,  complex  neuralgias  and  paranoics  phases,  alcohol- 
ism, and  various  other  neuroses.  The  slow  withdrawal  of 
opium  enables  one  to  discover  and  anticipate  these  neurotic 
troubles  which  have  been  masked  before.  In  one  case, 
suicidal  melancholy  ;  in  another,  hyperemia  of  the  brain, 
with  delusions  ;  in  the  third,  irritation  and  delirium  ;  in 
the  fourth,  hysterical  spasms  appeared  when  the  opium  was 
removed.  I  have  seen  two  cases  of  general  paralysis  sud- 
denly spring  into  great  activity  after  the  opium  was  taken 
away.  This  condition  was  not  suspected  before.  Alcohol- 
ism is  a  very  common  sequel  after  the  removal  of  the 
opium.  Cocaine,  chloral,  and  almost  every  drug  that  has 
narcotic  properties,  are  also  very  common  entailments. 

While  these  are  extreme  cases,  the)'  are  likely  to  appear 
at  any  time.  Great  care  should  be  exercised  in  using 
other  narcotics  to  lessen  tlie  irritation  from  the  withdrawal 
of  this  drug.  Foods  and  tonics  should  be  given.  These 
cases  require  the  same  general  treatment  as  neurasthenia 
and  other  states  of  brain  exhaustion.     They  are  drug-takers 


326  DISEASES   OF   INEBRIETY. 

and  will  resort  to  anything  for  relief.  They  are  secretive, 
and  require  more  care  and  more  mental  remedies,  with  long, 
exact  hygienic  surroundings. 

Where  tlie  opium  addiction  has  apparently  come  from 
bad  nutrition  and  faulty  elimination,  with  auto-intoxication, 
the  treatment  is  very  hopeful.  A  long  preliminary  course 
of  baths,  mineral  waters,  and  tonics  should  precede  the 
removal  of  opium.  Then  the  opium  may  be  removed  slowly 
and  without  the  knowledge  of  the  patient.  In  proper  sur- 
roundings, with  frequent  baths,  little  danger  of  relapse  or 
suffering  will  follow.  Careful  study  and  treatment  of  nutri- 
tion and  digestion  will  fully  restoie  the  case,  and  relapse 
seldom  occurs  except  from  failure  or  neglect  of  the  sur- 
roundings. 

In  the  last  class,  where  opium  is  taken  and  apparently 
follows  from  the  entailment  of  some  injury  or  disease,  or 
the  exhaustion  of  old  age,  a  preliminary  period  of  treatment 
seems  to  be  required.  Often  the  opium  can  be  abandoned 
at  once  for  sorrie  milder  narcotic,  and  from  this,  by  grada- 
tions, discontinued  entirely.  Full  knowledge  of  the  diseased 
states  present  Will  always  suggest  the  lines  of  treatment. 
In  some  cases  the  opium  should  not  be  removed  ;  its  dimi- 
nution and  concealment  is  required.  In  others,  its  rapid 
removal  is  essential.  Many  varied  and  difficult  questions 
will  appear  in  these  cases.  The  more  accurately  the  diseased 
states,  also  predisposing  and  exciting  causes,  the  diathesis, 
and  varied  influences  which  have  caused  opium  to  be  used, 
are  studied,  the  more  accurate  the  treatment.  As  in  many 
other  diseases,  the  causes  may  be  anticipated,  also  neutral- 
ized and  prevented.  Opium-taking  should  be  seen  as  a 
symptom  ;  remove  or  break  up  the  cause,  and  this  symptom 
disappears. 

Routine  treatment,  either  by  slow  or  rapid  reduction  of 
the  opium,  is  not  wise.  The  substitution  of  other  narcotics 
is  equally  unwise.  In  a  certain  number  of  cases  the  with- 
drawal of  opium  only  unmasks  more  serious  diseases,  and 


GENERAL    CONSIDERATIONS    OF    OPIUM    INEBRIETY.        827 

is  often  wrong.  A  case  of  general  paresis  is  now  under 
treatment  for  the  opium  addiction.  Before  this  opium 
addiction  began,  the  patient  caused  great  distress  by  his 
delusions  and  extravagantly  strange  conduct.  This  treat- 
ment is  wrong,  A  rheumatic  woman  of  seventy  is  going 
through  the  same  course  to  be  free  from  opium,  which  has 
made  life  tolerable  for  ten  years  past.  The  treatment  of 
opium  mania  is  something  more  than  the  application  of 
means  and  remedies  for  withdrawal  of  the  drug  with  the 
least  suffering.  The  symptomatology  and  organic  lesions 
often  date  back  to  other  causes  more  complex  than  opium. 
The  treatment  must  begin  by  their  removal.  The  general 
or  special  diathesis  must  be  treated  ;  the  nutritive  disorders, 
intoxications,  and  starvations  must  be  recognized  and  re- 
moved. The  influence  of  pathological  states  from  previous 
disease  and  injury  must  be  ascertained  and  treated.  The 
power  of  environment,  climate,  occupation,  and  idiosyn- 
crasies are  also  powerful  factors  to  be  considered. 

These  are  the  essential  facts  and  conditions  which  must 
enter  into  the  practical  treatment.  Among  the  many  im- 
portant problems,  that  of  prevention  promises  the  greatest 
possibilities.  A  recognition  of  the  neurotic  diathesis  and 
other  predisposing  causes  would  enable  the  physician  to 
successfully  guard  against  its  approach. 


CHAPTER  XXXII. 

OPIUM    INEBRIETY    (CONTINUED). 

In  the  special  treatment :  i.  We  have  to  deal  with  an 
individual  whose  will-power  is  subverted.  To  him  the 
enslaving  drug  has  become  as  much  a  necessity  of  existence 
as  his  food  and  drink.  Any  treatment  which  depends  upon 
his  own  volition  must  fail.  For  his  own  must  be  substituted 
the  control  of  another  sound  will.  As  a  rule,  removal  from 
home  is  essential  to  secure  this  control.  As  in  insanity  and 
hysteria,  strangers  have  far  more  control  than  relatives  or 
friends.  It  has  the  further  advantage  of  breaking  up  the 
accustomed  train  of  associations,  whicli  is  always  a  great 
aid  in  overcoming  a  confirmed  habit.  Special  asylums  have 
their  advantages  (if  under  proper  management)  and  their 
disadvantages.     I  shall  not  discuss  this  point. 

The  choice  of  attendant  is  of  great  importance,  as  upon 
his  or  her  trustworthiness  and  efficiency  the  result  may 
often  depend.  In  the  case  reported,  the  firmness  and  tact  of 
the  nurse,  her  readiness  with  massage,  bath,  medicine,  or 
nourishment,  etc.,  enabled  the  reduction  to  be  made  rapidly, 
and  assisted  greatly  in  mitigating  the  prostration  and  suf- 
fering of  the  patient.  With  inflexible  will  she  combined  a 
patience  and  sympathy  which  made  the  patient  feel  she  was 
a  strong  friend  to  help,  not  a  jailor  or  detective,  and  was 
thus  a  model  of  what  is  needed  in  the  attendant. 

2.  Control  of  the  patient  having  been  secured,  how  shall 
the  drug  be  taken  from  him  ?  Three  methods  have  their 
advocates  :  {a)  immediate  and  entire  withdrawal  ;  {l>) 
gradual  reduction  ;  {c)  rapid  reduction. 

329 


330  DISEASES    OF   INEBRIETY. 

Under  the  first  the  sufferings  are  intolerable,  the  pros- 
tration great  and  dangerous  and  it  does  not  offer  any  great 
security  against  relapse. 

In  the  majority  of  instances  tlie  rapid  reduction  is  the 
wiser  means  between  the  two  extremes.  The  rapidity 
should  vary  with  the  case,  and  should  be  such  as  not  to 
involve  extreme  suffering  or  great  prostration. 

3.  We  have  to  deal  in  all  cases  of  long  standing  with 
an  emaciated  body  and  starving  nerve  centers.  At  the 
same  time  we  have  complete  anorexia  and  feeble  digestion, 
perhaps  nausea  and  vomiting.  The  feeding  of  the  patient 
becomes,  therefore,  one  of  the  most  important,  and  perhaps 
most  difficult  parts  of  the  treatment. 

Often  it  is  well  to  begin  with  exclusive  milk  diet  (pep- 
tonized, if  necessary).  Systematic  feeding  of  small  quanti- 
ties at  frequent  intervals  is  usually  best.  Confinement  to 
bed  during  early  part  of  treatment  will  promote  the  nutri- 
tion. At  the  same  time  it  reduces  to  the  minimum  the  tax 
upon  the  shattered  nervous  system.  For  the  same  reason, 
as  well  as  for  the  sake  of  preventing  the  clandestine  supply 
of  the  drug,  seclusion  is  best  until  convalescence  is  well  estab- 
lished. 

The  good  results  of  the  "rest  treatment,"  as  advocated 
by  Mitchell,  /.  e.,  seclusion,  confinement  to  bed,  forced  feed- 
ing, massage,  and  electricity,  with  gradual  (usually  rapid) 
reduction  of  the  drug,  are  permanent. 

4.  The  use  of  various  mechanical  agencies  for  the  relief 
of  pain,  quieting"  tlie  nervous  system,  inducing  sleep  and  pro- 
moting nutrition — massage,  electricity  (both  faradism  and 
galvanism),  hot  baths,  Turkish  baths,  tlie  cold  shower-bath. 
Dr.  Jennings  recommends  the  hammock  for  the  restlessness 
and  desire  for  constant  motion,  so  often  a  distressing  symp- 
tom. 

5.  Medicinal  agents  to  meet  the  various  indications  of 
each  case. 

The  observations  of   Drs.  Jennings  and  Ball,  of  Paris, 


OPIUM   INEBKIETT    (cONTINDEd).  331 

upon  the  sph3'gmographic  tracings  of  the  pulse  of  habitues 
we  believe,  have  laid  the  physiological  basis  for  a  rational 
system  of  medication. 

These  observations,  which  have  been  confirmed  by  others, 
show,  "  that  the  pulse  of  a  morphine  habitue  in  a  state  of 
privation  ....  caused  by  want  of  cardiac  impulsion, 
together  with  a  resistance  to  the  passage  of  the  blood  in  the 
vessels.     A  hypodermic  or  morphia  given  at  this  moment 

restores  the  normal  state  of  the  circulation The 

study  of  these  tracings  suggested  the  use  of  cardiac  tonics 
and  stimulants  as  substitutes  for  the  morphia  during  the 
progressive  reduction."  The  drugs  chosen  were  :  "  Spar- 
teine, on  account  of  the  facilities  it  offers  for  hypodermic 
injection,  and  producing  thus  a  rapid  and  evident  effect  ; 
and  trinitin,  because  of  its  congestive  effect  on  the  head  and 
its  calorific  effect  upon  the  body  generally." 

D«'.  Jennings  uses  these  remedies  in  the  gradual  suppres- 
sion of  the  drug  when  the  reduction  has  reached  such  a 
degree  as  to  bring  on  the  symptoms  of  deprivation.  It  is 
not  to  be  understood  that  these  drugs  take  the  place  of 
morphia,  i.  e.,  that  it  can  be  at  once  omitted  without  the 
usual  suffering  ;  tliey  are  but  aids  in  mitigating  that  suffer- 
ing by  counteracting  some  of  the  circulatory  disturbances 
upon  which  it  largely  depends. 

The  evidence  of  clinical  experience  is  largely  in  favor  of 
heart  tonics  and  stimulants  rather  than  of  sedatives.  In 
the  case  reported,  no  sedatives  were  given,  yet  after  the 
first  few  nights,  sleep  was  good.  The  glonoin  had  certainly 
a  good  effect,  being  given  at  the  time  when  the  symptoms 
of  the  craving  came  on.  Quinia  was  used  as  a  stimulant 
to  the  heart  and  the  cerebral  circulation.  Strychnia  was 
given  as  a  heart  tonic  after  complete  withdrawal  of 
morphia. 

When  nervousness  is  great,  or  insomnia  does  not  yield 
to  other  means,  drugs  may  be  necessary.  In  these  instances, 
cannabis  indica  in   large  doses  {}i  to  i  drachm  of  fl.  ext.)^ 


332  DISEASES    OF  INEBEIETT. 

sulfonal,  chloralamid  or  bromides  will  often  render  good 
service.  Chloral  is  used  by  Erlenmeyer,  condemned  by 
Aurleck  and  others.  Dr,  Jennings  seems  latterly  to  have 
usually  substituted  digitalis /^r^.y  forspartein  hypodermati- 
cally,  Quinia  has  seemed  to  me  in  many  cases  of  distinct 
value.  Strychnia  is  one  of  the  best  heart  tonics  in  the 
pharmacopoeia. 

Obersteiner  is  almost  the  only  w^riter  of  note  who  now 
speaks  well  of  cocaine.  If  used  at  all,  it  should  never,  of 
course,  be  placed  in  the  hands  of  the  patient  himself.  The 
f^uid  extract  of  coca  has  been  highly  spoken  of  by  several 
writers  to  relieve  restlessness  and  depression.  Valerianate 
of  ammonia  has  been  a  common  favorite  since  the  time  of 
De  Quincy. 

This  method,  which,  so  far  as  we  are  aware,  is  original 
with  and  peculiar  to  Dr.  Mathison,  is  merely  a  new  applica- 
tion of  a  well-established  principle,  for  the  power  of  the  bro- 
mides to  subdue  abnormal  reflex  irritability  is  so  constant 
that  it  may  be  looked  upon  as  an  invariable  sequel  of  such 
medication.  Dr.  Ed.  H.  Clarke,  in  his  valuable  treatise  on 
the  bromides,  says  :  "  Diminished  reflex  sensibility,  however 
different  physiologists  may  explain  the  fact,  is  cne  of  the 
most  frequent  piienomena  of  bromidal  medication  that  has 
been  clinically  observed,  and  is,  therapeutically,  one  of  the 
most  important."  The  testimony  of  other  distinguished 
observers  is  to  the  same  effect — Gubler,  Guttman,  Laborde, 
Voison,  Damourette,  Eulenberg,  Claude  Bernard,  Brown- 
Sequard,  Echeverria,  and  Hammond  all  giving  evidence  as 
to  the  power  of  these  agents  to  impair  the  control  of  the 
spinal  cord  over  reflex  manifestations,  and,  at  the  same 
time,  exert  a  marked  influence  over  the  general  nervous 
system.  Admitting  that  the  symptomatology  of  opiate 
abandonment  pertains  almost  exclusively  to  the  functions 
over  which  the  bromides  exert  so  decided  a  control,  we 
have  in  the  treatment  of  opium  inebriety  a  new  field  pre- 
sented  for  the  exercise  of  this  valuable  property,  and  the 


OPmM   INEBRIETY   (cONTINTJEd).  333 

fact,  proven  conclusively  by  our  experience,  that  it  ^(^^j- exert 
this  happy  effect,  fully  supports  the  idea  advanced  as  to 
pathology  of  this  disease. 

In  speaking  of  the  bromide  of  sodium,  let  it  be  under- 
stood that  we  refer  entirely  to  the  influence  of  the  continued 
dose,  by  which  we  mean  its  administration  three  times  in 
the  twenty-four  hours,  at  regular  intervals,  so  as  to  keep 
the  blood  constantly  charged  with  the  drug.  A  most 
important  difference,  physiological  and  therapeutical,  exists 
between  the  effect  of  this  mode  of  exhibition  and  that  of 
the  single  dose,  or  two  or  three  doses  so  nearly  together  as 
to  form  practically  one.  for  in  the  former  case  the  system  is 
constantly  under  the  bromide  influence,  while  in  the  other, 
the  drug  being  largely  eliminated  in  a  few  hours,  the  blood 
is  nearly  free  from  it  a  large  portion  of  tlie  time.  Results 
obtainable  from  the  continued  use  cannot  be  gotten  from 
the  single  dose,  and,  as  a  consequence,  its  value  is  far 
greater  in  the  disease  under  consideration. 

Again,  the  action  of  the  continued  dose  being  somewhat 
remote,  three  to  five  days  usually  elapsing  before  there  is 
decided  evidence  in  this  direction,  much  more  desirable 
results  are  secured  by  its  employment  for  several  days/r/^r 
to  an  entire  opium  abandonment,  meanwhile  gradually 
reducing  the  opiate,  than  if  the  withdrawal  be  complete  and 
then  reliance  placed  on  the  bromide  to  control  the  result- 
ant irritability  ;  for,  in  one  instance,  the  maximum  sedative 
effect  is  reached  at  the  period  of  maximum  disturbance 
from  the  opium  removal,  and  its  counteracting  and  con- 
trolling effect  is  far  in  excess  of  that  to  be  had  from  its 
employment  subsequent  to  the  lighting  up  of  the  nervous 
irritation.  What,  then,  we  style  preliminary  sedation  forms 
a  peculiar  and  most  valuable  feature  in  our  administration 
of  the  bromide,  and  it  is  this  particular  point  we  commend 
to  you,  our  experience  having  convinced  us  we  have  in  it 
an  unequaled  means  of  obviating  the  suffering  incident  to 
the  treatment  of  this  disorder.  v 


334  DISEASES    OF   INEBRIETY. 

The  value  of  the  various  bromides  depends'on  their  pro- 
portion of  bromine.  Bromide  of  potassium  contains  66  per 
cent.,  sodium  78,  and  lithium  92  per  cent.  We  should, 
therefore,  expect  a  more  powerful  influence  from  the  latter 
agent,  and,  according  to  Wier  Mitchell,  it  has  a  more  rapid 
and  intense  effect.  Bromide  of  sodium  being  richer  in  bro- 
mine, and  pleasanter  to  the  taste,  we  prefer  it  to  potas- 
sium. 

Either  of  the  bromides,  in  powder  or  concentrated  solu- 
tion, is  somewhat  irritant,  sometimes  provoking  emesis,  and, 
in  any  event,  delaying  its  absorption.  A  practical  point, 
then,  is  that  it  be  given  largely  diluted.  Dr.  Clarke  says, 
"  There  should  be  at  least  a  drachm  of  water  to  each  grain 
of  the  salt."  We  give  each  dose  of  the  sodium  in  six  or 
eight  ounces  of  cold  water,  and  have  never  known  it  to 
cause  vomiting. 

Another  important  feature  relates  to  the  time  of  its 
employment.  We  usually  administer  it  at  10  a.  m.,  4  and  10 
p.  M.,  or  half  an  hour  before  each  meal.  Given  thus,  largely 
diluted,  it  is  probably  absorbed  in  half  an  hour,  and  the 
effect  of  tlie  continued  dose  rapidly  secured. 

To  produce  the  requisite  degree  of  sedation  within  a 
limited  period,  it  is  essential  that  the  bromide  be  given  in 
full  doses.  I  am  convinced  that  failure  in  its  use,  in  any 
neurosis,  is  very  often  due  to  a  non-observance  of  this 
point.  Our  initial  dose  of  the  sodium  is  30  grains,  twice 
daily,  time  and  mode  as  stated,  increasing  the  daily 
amount  30  grains  each  day,  i.  e.,  40,  50,  60  grains  and 
continuing  it  eight  days,  reaching  a  maximum  dose  of 
100  grains  twice  times  in  the  twenty-four  hours.  It  is  then 
discontinued,  but  its  sedative  effect  persists  and  somewhat 
increases  for  two  or  three  days  following,  and  then  begins 
to  decline.  This  period  may  last  a  week  or  more  depend- 
ing on  some  state  of  the  blood  and  power  of  elimination. 
During  this  week  of  bromidal  medication,  the  usual 
opiate    is   gradually  reduced,   so    tliat   oa   the   seventh  or 


OPIUM    INEBRIETY    (oONTINDEd).  335 

eighth  day  it  is  entirely  abandoned.  A  decrease  of  one- 
third  or  one-half  the  accustomed  daily  quantity  is  made  at 
the  outset,  experience  having  shown  that  habitues  are 
almost  always  using  an  amount  in  excess  of  their  actual 
need,  and  this  decided  reduction  occasions  little  or  no  in- 
convenience. Subsequently,  the  opiate  withdrawal  is  more 
or  less  rapid  according  to  the  increasing  sedation,  llie  object 
being  to  meet  and  overcome  the  rising  nervous  disturbance 
by  the  growing  effect  of  the  sedative — in  other  words, 
maximum  sedation  at  time  of  maximum  irritation. 

Having  secured  the  sedative  effect  desired,  the  object  is 
to  eliminate  the  bromide  as  rapidly  as  possible,  and  as  the 
skin  and  kidneys  form  the  only  outlets,  recourse  is  had  at 
once  to  diaphoretics  and  diuretics.  Of  the  former,  hot  and 
steam  baths  are  to  be  relied  upon.  And,  of  the  latter,  digi- 
talis, in  infusion,  or,  if  bulk  be  objectionable,  Squibb's  fluid 
extract  combined  with  potass,  acet.  and  spirits  aether  nitrosi. 
The  bromide  itself  increases  renal  secretion,  and,  aided  by 
the  others,  it  passes  from  the  system  in  a  few  days.  The 
bromide  and  opiate  having  been  discontinued,  restlessness, 
more  or  less  prominent,  from  20  to  56  hours,  invariably  sur 
pervenes.  It  is  controlled  by  codeine,  i  to  3  grains  sub- 
cutaneously,  or  by  mouth,  every  2  to  4  hours,  and  this  is 
continued,  decreasing  the  dose  or  increasing  the  interval 
till  no  longer  needed,  but  is  greatly  relieved  by  hot — not 
warm — baths,  temperature  110°  to  112°,  15  to  30  minutes 
duration,  repeated  as  required.  They  are  often  signally 
effective.  We  have  known  a  patient  fall  asleep,  snoring 
vigorously,  while  in  a  bath. 

Sleeplessness  is  always  more  or  less  prominent  after 
opium  abandonment.  During  the  first  six  nights,  sulfonal 
or  trional  in  30  or  40  grain  doses  is  given.  Afterward,  such 
hypnotic  as  seems  best  suited  to  the  case  ;  cliloral  is  most 
effective,  in  20  or  30  grain  doses  at  bedtime.  Often  smaller 
doses  may  be  given  at  intervals  of  two  hours  until  sleep 
follows,  with  good  results. 


336  DISEASES    OF   INEBRIETY. 

A  peculiarity  of  this  insomnia  is,  that  it  is  most  marked 
in  the  early  morning.  Slumber  comes  readily  enough 
at  niglit,  but  patient  awakes  at  two,  three,  or  four  oclock, 
and  finds  further  sleep  impossible.  Often  it  is  well  to 
defer  the  sleeping  draught  until  this  time.  This  wak- 
ing tendency  gradually  diminishes,  and  ultimately  dis- 
appears. 

Chloral,  given  during  the  early  opium  abstinence,  has, 
with  us,  not  acted  kindly  as  a  hypnotic,  but  produced  a 
peculiar  intoxication,  though  we  have  never  noted  the  wild, 
maniacal  delirium  mentioned  by  Dr.  Levenstien  as  occur- 
ring during  this  period  in  his  cases.  As  soon  as  possible  it 
should  be  discontinued,  and  sleep  secured  by  a  fatiguing 
walk,  a  half  hour's  warm  bath,  a  light  lunch,  or  glass  of 
milk — one  or  all,  before  retiring. 

For  three  or  four  days  following  the  opiate  withdrawal, 
the  diet  should  be  exclusively  of  milk  combined  with  lime- 
water — one  or  two  ounces,  with  one  or  two  drachms  respect- 
ively— every  hour  or  two.  It  is  very  seldom  rejected,  and  is 
preferable  to  beef  tea,  or  anything  else.  Afterwards,  a  full, 
solid  diet  may  be  resumed,  soon  as  practicable. 

While  diarrlicea  is  the  decided  exception  under  this  plan 
of  treatment,  we  still  deem  it  best  to  keep  the  bowels  in 
good  condition,  and  administer  the  first  night,  a  mercurial 
cathartic  sufficient  for  several  full  evacuations,  followed, 
during  the  bromide  giving,  by  daily  laxative  enemas,  or 
doses  of  Hunyadi  water. 

Debility,  of  varying  d  egree,  due  to  the  opium  abstinence, 
and  bromide  relaxation,  is  among  the  sequelae.  It  decreases 
with  the  increasing  bromine  elimination,  aided  most  effect- 
ively by  general  faradization,  twenty  minutes  morning 
seances  daily,  after  the  restlessness  subsides,  and  strychnia 
I-20  gr.  thrice  daily,  combined  with  iron,  quinine,  phospho- 
rus, digitalis,  or  cod  liver  oil,  as  most  required. 

The  following  formulae  are  valuable  : 


OPIUM   INEBRIETY   (CONTINUED).  337 

Be.  Strychnine,  two  grains  ;  Muriated  Tinct.  Iron,  five  ounces  ; 
Tinct.  Digitalis,  and  Glycerine,  of  each,  two  and  one-half  ounces. 
M.     Dose — One  to  two  drachms,  three  times  daily. 


5.     Strychnine,  four   grains  ;  Dialized    iron,  five   ounces.     M. 
Dose,  one-half  drachm,  ter  in  die. 


R.  Strychnine,  two  grains  ;  Dilute  Phosphoric  acid,  and  Syrup 
of  Ginger,  of  each,  two  and  one-half  ounces.  M.  Does — One 
drachm  thrice  daily. 


R.  Pyrophosphate  of  Iron,  5  to  10  grs.,  Quinme,  2  grs.  at  a 
dose.  M.  Pill,  or  solution,  three  times  a  day,  if  the  appetite  be 
slow  in  returning. 


'Be.  Comp.  Tinct.  Quassia,  one  drachm ;  Tinct.  Capsicum,  ten 
drops.     M.     For  one  dose,  diluted,  20  minutes  before  each  meal. 

Strychnia  is  not  advisable  during  the  bromide  adminis- 
tration. Being  decidedly  antagonistic — one  causing  relax- 
ation and  deficient  reflex  excitability,  the  other,  just  the 
reverse — the  desired  sedative  effect  may  be  materially 
delayed  if  they  be  given  together.  Subsequently,  it  is  the 
most  valued  general  tonic  at  command,  and  may  be  con- 
tinued in  varied  combination  for  weeks.  With  the  strictly 
medicinal  course  are  to  be  employed  a  full  nutritious  diet, 
out-of-door  exercise,  especially  walking,  and  varied  social 
enjoyments — in  fact,  anything  that  can  exert  a  roborant 
effect  on  mind  or  body. 

Surprise  may  be  expressed,  and  objection  made  regard- 
ing the  extent  of  the  bromide  doses,  but  the  fact  must  never 
be  overlooked  that  we  are  not  to  be  governed  in  the  giving 
of  any  remedy  by  the  mere  numerical  amount  of  drops  or 
grains,  but  by  the  effect  produced.  Again,  I  am  led  to  think 
that  one  effect  of  opium  addiction  is  a  peculiar  non-suscep- 
tibility to  the  action  of  various  nervines,  necessitating  their 
more  robust  exhibition  to  secure  a  decided  result.  More, 
and   most  important  of  all,  under  the  influence   of   certain 


338  DISEASES    OF   INEBKIETY. 

abnormal  conditions,  doses  which  ordinarily  are  toxic  be- 
come simply  therapeutic.  The  annals  of  medical  literature 
abound  with  illustrations  in  support  of  this  statement,  and 
among  the  most  striking  may  be  noted  the  following  :  Dr. 
Southey  read  before  the  Clinical  Society  of  London  notes  of 
a  case  of  idiopathic  tetanus,  which  occurred  in  a  boy  ten 
years  old.  The  first  symptoms  of  trismus  were  observed 
two  days  after  a  severe  fright  and  drenching  due  to  the  up- 
set of  a  water-butt.  They  steadily  increased  up  to  the  date 
of  liis  admission  to  St.  Bartholomew's  hospital,  upon  the 
eighth  day  of  his  illness,  when  the  paroxysms  of  general 
opisthotonos  seized  him  at  intervals  of  nearly  every  three 
minutes.  Each  attack  lasted  from  fifteen  to  thirty  seconds* 
and  although  between  the  seizures  the  muscles  of  the  trunk 
became  less  rigid,  those  of  the  neck  and  jaw  were  maintained 
in  constant  tonic  cramp.  The  patient  was  treated  at  first 
with  chloral,  ten  grains,  and  bromide  of  potassium  twenty 
grains,  every  two  hours,  and,  afterwards,  with  the  bromide 
alone  in  sixty  grain  doses  every  hour  and  a-half.  When 
about  two  ounces  were  taken  in  the  twenty-four  hours,  the 
attacks  became  less  frequent,  but  at  first  each  separate  seiz- 
ure was  rather  more  severe,  and  upon  the  evening  of  the 
eleventh  day,  he  was  able  to  open  his  mouth  better. 

On  the  thirteenth  day  the  bromide  was  decreased  to 
twenty  grains  every  three  hours,  and  on  the  fourteenth  day, 
was  discontinued  altogether.  When  the  bromide  had  been 
omitted  for  twenty-four  hours,  the  attacks  returned  at  inter- 
vals of  an  hour,  and  the  permanent  rigidity  of  the  muscles 
of  the  neck  was  re-established.  His  condition  now  steadily 
became  worse,  so  that  on  the  eighteenth  day  of  his  illness 
it  became  necessary  to  resort  to  the  previous  large  doses — 
one  drachm — every  hour  and  a-half.  After  three  such  doses, 
the  expression  became  more  natural,  and  he  was  able  to 
open  his  mouth  again  ;  but  it  was  not  till  the  twenty-fifth 
day  of  the  disease  that  it  was  possible  to  discontinue  the 
remedy.     The  patient  remained   in  a  state  of  remarkable 


OPIUM  iNEBRiETy  (continued).  339 

prostration  and  drowsiness,  sleeping  the  twenty-four  hours 
round,  and  only  waking  up  to  take  his  nourishment  for 
eight  days,  and  passed  all  his  evacuations  under  him.  He 
subsequently  steadily  and  rapidly  convalesced.  The  bro- 
mide produced  no  acne  or  other  disagreeable  symptoms, 
and  certainly  appeared  to  exert  marked  inhibitory  influence 
upon  the  tetanus. 

Surely,  under  ordinary  circumstances,  no  one  would 
think  of  giving  such  extensive  doses  of  the  bromide,  but 
liere,  under  the  antagonizing  influence  of  the  intense  reflex 
irritability,  their  effect  was  vastly  beneficial,  conducing, 
unquestionably,  to  the  patient's  cure. 

Given,  as  we  recommend,  no  effect  is  usually  produced 
by  the  bromide  before  the  third  day.  From  the  third  to  the 
fifth,  an  unpleasant  taste  is  complained  of  ;  the  bromic 
breath  begins  ;  the  patient  is  disposed  to  drowse,  and  there 
is  a  growing  indisposition  to  muscular  exertion.  From  the 
fifth  to  the  seventh,  these  symptoms  increase — the  tongue 
begins  to  furr  ;  the  odorous  breath  is  marked  ;  the  drowsi- 
ness deepens  into  sound  sleep,  more  or  less  prolonged,  and 
the  inaptitude  for  physical  exercise  becomes  so  decided,  that 
patients  generally  take  to  bed  on  the  last  day.  The  follow- 
ing two  or  three  days — during  the  period  of  maximum  dis- 
turbance from  the  opium  withdrawal — are  characterized  by 
a  persistence  of  the  symptoms  alluded  to.  Patient  remains, 
more  or  less  restlessly,  in  bed;  general  relaxation  is  decided; 
the  pulse  is  less  frequent — usually  about  60  :  the  voice 
somewhat  weakened  ;  pupils  dilated  ;  the  renal  secretion 
augmented — though,  sometimes,  diminished  ;  the  saliva 
increased  and  rather  viscid,  and  mild  hallucinations  of  sight 
and  sound — almost  always  of  sight — occur,  occasionally,  for 
tliree  or  four  days,  accompanied  with  a  peculiar  aphasic 
tendency,  as  shown  by  substituting  one  word  for  another — 
Mediterranean  for  Mississippi;  Brown,  instead  of  Iowa,  etc. 
This  curious  symptom  may  occur  at  increasing  intervals  for 
several  days. 


340  DISEASES   OF    INEBRIETY. 

Dr.  Clarke  refers  to  such  instances.  He  says:  "They 
are  hints  of  a  distinct  organ  of  hmguage,  and  suggest  the 
notion  that,  inasmuch  as  the  drug  we  are  considering  para- 
lyzes reflex,  before  it  does  general  sensibility,  language 
may  be  the  expression  or  correlation  of  a  peculiar  reflex 
power." 

After  the  ninth  or  tenth  day,  the  bromidial  manifesta- 
tions gradually  disappear,  so  that  within  two  weeks  from 
beginning  of  treatment,  patient  is  generally  up  and  the 
only  prominent  symptoms  remaining  are  the  debility  and 
insomnia.  Tonics,  hypnotics,  and  vis  medicatrix  naturae 
effect  speedy  convalescence,  and — where  treatment  is  begun 
on  entrance — patients  are  usually  dismissed,  cured,  within 
a  month. 

More  than  one  week's  employment  of  the  sodium  is  not 
advisable  lest  the  hallucinations  become  unpleasantly  pei"- 
sistent  ;  and  cases  will  present  in  which  a  minor  degree  of 
administration — five  or  six  days — will  suffice. 

Marked  general  debility  contra-indicates  the  bromide, 
and  a  tonic  course  should  precede  it. 

Granted  a  case  suitable  for  treatment,  tliis  method  may- 
be summarized  as  follows  :  Opiate  reduced,  at  once,  to 
one-half  or  two-thirds  usual  quantity.  Subsequent  grad- 
ual decrease  and  entire  withdrawal  in  seven  or  eight 
days.  Mercurial  cathartic,  first  night,  followed  by  daily 
laxative  enemas,  or  Hunyadi  water.  Bromide  of  sodium, 
30  grain  doses,  increased  30  grains  daily,  in  six  or  eight 
ounces  water,  on  empty  stomach,  continued  5  to  7  days. 
Restlessness  following  opium  abandonment  met  by  hot 
baths,  100''  to  110°,  ten  to  thirty  minutes  each,  often  as 
required.  Bromide  eliminated  by  diuretics — digitalis  and 
nitre,  and  diaphoretics — hot  and  steam  baths.  Insomnia 
relieved  by  chloral,  combined,  if  need  be,  with  Indian 
hemp  or  hyoscyamus.  Diet  exclusively  milk  and  lime- 
water  first  three  days  of  opium  abstinence.  Full  diet 
resumed  soon  as  possible.     Debility  removed  by  generous 


OPIUM   INEBRIETY   (cONTINTJEd).  341 

living,  general  faradization,  strychnine,  iron,  quinine,  etc., 
with  out-of-door  exercise  and  varied  social  enjo3'ment. 

For  relief  of  neuralgic  pain  varied  measures  suffice. 
Leading  the  list  are  electricity  and  the  local  use  of  ether. 
As  to  the  value  of  the  galvanic  current  in  migraine  and 
other  neuralgias,  so  common  in  opium  habitues,  and  the 
manner  of  using  it,  tlie  reader  is  referred  to  papers  by  the 
writer.  The  same  agent  is  effective  in  relieving  limb  and 
lumbar  pains,  tliough  here  a  much  stronger  current  is 
required  than  can  be  used  with  safety  about  the  head. 
Sometimes  a  faradic  current  acts  well,  and  when  one  fails, 
trial  should  always  be  made  with  the  other.  Local  hot 
baths  are  often  of  great  service. 

Regarding  the  ether,  those  who  have  never  used  it  will, 
we  think,  be  surprised  at  its  pain-easing  power.  In 
either  way  applied — spray,  drop,  or  lavement — it  is  potent 
for  good. 

These  three — electricity,  ether,  hot  water,  are  valued 
anodynes,  and  one  special  point  in  their  favor  is  entire  free- 
dom from  unpleasant  gastric,  or  other  result. 

Other  remedies  relieve,  at  times,  of  the  coal-tar  salts, 
phenacetine,  or  phenocoll,  lo  to  15  gr.  doses  are  best.  It 
has  often  a  hypnotic  effect.  A  valued  external  anodyne  is 
menthol,  i  part ;  chloroform,  10  parts  ;  ether,  15  parts  ;  used 
as  spray. 

Under  this  plan  of  treatment  marked  disorder  of  stomach 
or  bowels  is  rare.  Our  rule  is  to  give  a  mercurial  or  other 
cathartic  at  the  outset,  if  there  be  alvine  torpor,  and  then 
secure  regular  action  by  such  laxative  as  seems  best.  If 
restraint  be  needed,  large  enemas  of  hot  water  may  be  used. 
Tills  failing,  i  to  3  grs.  sulpho-carbolate  of  zinc,  10  to  20 
minim  doses  of  fluid  extract  of  coto,  in  capsules,  or  40  to 
60  grains  of  subnitrate  of  bismuth  every  four  hours.  If, 
however,  it  persists,  the  best  thing  is  a  full  opiate — tinct, 
opii,  per  mouth  or  rectum,  at  bedtime,  preferred.  This 
promptly  controls,  gives  a  full  night's  sleep,  and  the  trouble 


342  DISEASES   OF   INEBRIETY. 

seldom  returns.  Fear  of  a  bad  effect  on  convalescence  is 
unfounded. 

Diet  is  not  restricted,  unless  tlie  condition  of  stomach  or 
bowels  demands.  We  have  again  and  again  seen  patients 
recover  who  did  not  vomit  once,  or  wlio  liad  only  two,  three 
or  four  movements  daily,  Tlie  excessive  vomiting  men- 
tioned by  Levinstein  and  Obersteiner — abrupt  disuse — we 
have  never  noted.  Tiie  former  thought  tlie  collapse — which 
we  have  never  seen — in  several  of  his  cases  was  due  to 
vomiting  and  purging.  More  likely  the  largest  factor  in 
causing  it  was  tlie  exhausting  mental  and  physical  suffer- 
ing which  his  metliod  entails.  If  the  stomach  rebels, 
entire  rest  for  a  time,  or  milk  and  lime-water,  ale  and  beef, 
malted  milk  or  bovinine,  in  small  amount,  may  act  well.  If 
not,  sinapisms,  ether,  faradism,  or  chloroform,  alcohol  and 
ice  are  of  value.  All  failing,  a  full  opiate  hypodermic  will 
promptly  suffice. 

Twenty-four  hours  after  the  opiate-quitting,  patients  are 
directed  to  bed,  and  kept  there  two  to  four  days,  for  we 
are  convinced  that  rest  is  an  aid  of  great  value.  Erlen- 
meyer  says,  "The  best  remedy  is  rest  in  bed.  The  import- 
ance of  quiet,  rest  in  bed,  and  warmth  in  promoting 
restoration  during  the  abstinence  struggle,  cannot  be 
overestimated.  I  order  every  patient  to  bed  at  the  start, 
and  can  state  with  confidence  that  those  who  submit  to  this 
till  I  allow  a  change  will  get  along  more  easily  and  satis- 
factorily during  the  treatment  than  others  who  do  not  obey, 
but  who  insist  on  moving  about  or  having  the  run  of  the 
premises." 

Having  thus  crossed  the  opiate  Rubicon,  treatment  per- 
tains, mainly,  to  the  debility  and  insomnia.  For  the 
former,  coca  leads  the  list.  Of  fluid  extract,  2  to  4  drachms, 
or  cocaine,  i  to  2  grains,  with  other  tonics,  3  or  4  times 
daily,  decreasing  as  need  lessons.  As  a  rule,  its  use  is 
ended  in  a  fortniglit.  To  remove  the  mental  and  physical 
depression,  the  minor   neuralgias,  and   the  desire  for  stimu- 


OPIUM   INEBKIETT   (cONTINUEd).  343 

lants  sometimes  noted  nothing  equals  it,  and  full  doses  of 
tincture  of  capsicum  often  add  to  its  value. 

Another  agent  of  much  service  is  general  faradization, 
twenty  minute  stances  daily.  This  imparts  a  feeling  of 
exhilarating  comfort,  but  care  must  be  taken  not  to  overdo, 
for  a  current  too  strong  or  long  makes  mischief,  overstimu- 
lating  and  exhausting  to  the  extent,  it  may  be,  of  several 
days'  discomfort,  which  nothing  but  time  will  remove. 

Faradism  also  acts  kindly  in  easing  the  peculiar  unrest 
— "  fidgets  " — and  the  nagging  aches  in  legs  during  con- 
valescence. It  may  be  applied  in  the  usual  way,  or  througli 
the  special  electrodes  we  have  devised. 

Galvanism  is  another  general  tonic  of  value.  Our 
method  is  positive  pole  to  nape  of  neck  and  negative  to 
epigastrium  for  five  minutes,  then  the  former  behind  tiie 
angle  of  each  jaw  for  a  minute  or  two,  making  entire 
stances  seven  to  nine  minutes. 

Another  valued  tonic  is  the  cold  shower-bath.  With 
many  it  is  a  great  invigorator,  and  patients  who  dread  it, 
at  first,  came  to  appreciate  it  highly. 

Internal  tonics  have  a  place  in  the  roborant  regime. 
Most  habitues  are  below  par,  and  it  is  our  custom  to  give 
such,  from  the  start — phosphorus,  strychnine,  arsenic  and 
quinine,  combined.  After  the  opiate-quitting,  coca,  in 
some  form,  can  be  added.  If  anaemic,  ferri  tincture,  or 
Blancard's  pills.  Caffein  is  of  value.  It  is  stimulant,  tonic 
and  diuretic.  We  sometimes  give  it  with  codeine  and 
cocaine.  Digitalis  is  often  useful.  In  some  cases,  cod- 
liver  oil  is  of  service — with  pepsine  and  quinine,  with  malt, 
with  phosphates,  or  plain — and  may  be  given  for  months. 

Some  anorexia  is  usually  present,  yet  it  may  not  prevent 
the  regular  meal,  and  need  never  occasion  anxiety,  for  it 
will  likely  give  place  to  a  vigorous  appetite,  whicli  may  be 
encouraged  to  fullest  feeding  siiort  of  digestive  disaster. 
If  it  be  slow  in  returning,  half  grain  doses  of  cannabis,  an 
hour  before  meals,  often  have  a  marked  action. 


344:  DISEASES   OF   INEBRIETY. 

Regarding  the  insomnia,  Levinstein  said  :  "  Sleepless- 
ness, which  is  generally  protracted  up  into  the  fourth  week, 
is  very  distressing."  Our  record  differs.  Wakefulness  is 
an  invariable  sequel,  but  usually  not  so  marked  nor  pro- 
longed, and  in  ordinary  cases  recovery  can  generally  be 
promised,  without  the  loss  of  a  single  entire  night's  sleep. 
We  have  known  a  patient  able  to  dispense  with  hypnotics 
in  five,  others  in  eight,  and  the  average,  in  a  series  of  cases, 
was  eleven  nights. 

The  insomnia  is  of  two  kinds.  Most  patients  secure 
sleep  on  retiring,  but  waken  early — 3  or  4  o'clock — and  fail 
to  get  more.  Others  remain  awake  nearly  all  night  before 
slumber  comes,  and  these  usually  require  soporifics  the 
longer.  For  relief  of  this,  cannabis  indica  will  often  suffice. 
The  hemp  is  given  in  40-  to  60-minim  doses,  in  capsules,  or 
mixed  with  glycerin,  or  ginger  syrup,  two  hours  before  bed- 
time. There  may  be  noted,  in  some,  laughing  and  talking 
during  the  first  hour,  tending  to  sleep  in  the  second. 
Many  require  nothing  else.  At  the  end  of  a  week  it  is  less- 
ened, and  usually,  ended  in  ten  or  twelve  days. 

Other  hypnotics — chloral,  chloralamid,  trional,  sulfonal, 
paraldehyde,  hypnal — in  full  doses,  often  work  well. 

Chloral,  during  the  first  5  or  6  nights  of  opium  abstin- 
ence, fails  as  a  soporific,  often  causing  a  peculiar  excite- 
ment or  intoxication — patients  talking,  getting  out  of  bed 
and  wandering  about  the  room — followed  after  several 
hours,  by  partial  sleep.  Later,  in  full  doses — we  prefer 
40  grains  at  once,  rather  than  two  20  grain  doses — alone,  or 
with  a  bromide,  it  can  be  relied  on. 

If,  as  rarely  happens,  the  sleepless  state  is  so  pronounced 
or  prolonged  as  to  distress  patient,  we  never  hesitate  to 
give  a  full  opiate,  by  mouth,  and  with  good  result.  Erlen- 
meyer  says:  "In  such  cases  there  remains  nothing  to  do 
but  to  resort  to  morphine.  I  give,  then,  the  alkaloid  inter- 
nally on  two  consecutive  evenings  ;  a  certain  cumulative 
effect  takes  place.     The  first  night  in  the  dose  of  Yi  grain, 


OPIUM   INEBRIETY    (cONTINUEd).  345 

there  is  usually  no  sleep  ;  but  on  the  second  night,  after 
giving  the  same  dose,  a  sound  sleep  of  six  hours'  will 
ensue.  I  have  not  observed  any  special  danger  from  these 
resumed  doses  of  morphine,  although  I  feared  it  ;  but  after 
I  was  constrained  in  several  bad  cases,  when  every  other 
medicine  had  failed,  to  resort  to  this,  I  was  convinced  that 
my  fear  was  groundless." 

In  all  cases  drugs  should  be  dropped  as  soon  as  pos- 
sible, and  sleep  secured  by  a  walk  or  other  exercise — an 
electric  seance,  a  Turkish  or  half-hour's  warm  bath,  a  light 
meal,  a  glass  or  two  of  hot  milk,  one  or  more  of  these  before 
retiring.  Patients,  whose  slumber  ends  early,  often  note  a 
peculiar  depression  on  waking,  and  if  so,  a  lunch,  hot 
milk,  cocoa,  coffee,  beef,  or  bovinine  should  be  at  com- 
mand. 

It  may  be  well  in  passing  to  refer  to  certain  minor 
sequelae  and  their  treatment.  If  dyspnoea  or  palpitation,  a 
stimulant — coca  with  capsicum  or  Hoffman's  anodyne 
with  aromatic  spirits  of  ammonia — will  promptly  control. 

If  aching  pains  in  the  calves,  strong  galvanic  or  faradic 
currents,  hot  water,  massages,  or  ether  will  relieve.  If  a 
peculiar  burning  in  soles,  mustardized  foot-baths.  If 
marked  hysteria,  ether  inhalations. 

Belly  pain  may  be  eased  by  hot  fomentations,  or  full 
doses  of  ether  in  hot  water,  or  camphor  with  capsicum. 
The  latter,  with  atropine  injection,  act  happily  in  ovarian 
irritation. 

Very  seldom  unrest  and  insomnia  compel  hyoscine.  If 
so,  hydrobromate  i-ioo  to  1-20  grain,  hypodermically,  or, 
double,  by  mouth. 


CHAPTER  XXXIII. 

ETHER  INEBRIETY — ITS  HISTORY  AND  PROGRESS. 

Ireland  has  in  the  nineteentli  century  presented  to  the 
world  two  interesting  and  remarkable  series  of  inobrio- 
psycliological  piienomena.  In  1838,  a  simple-minded 
Roman  Catliolic  priest,  Fatiier  Matliew,  adopted  and  be- 
gan to  advocate  the  practice  of  abstinence  from  all  intoxi- 
cating drinks.  So  amazing  was  the  impression  made  by 
him  that,  in  three  years,  the  roll  of  the  teetotal  pledges 
which  he  had  administered  exceeded  5,000,000,  in  Ireland, 
in  aiddition  to  large  numbers  in  England,  Scotland  and 
America.  The  reality  of  this  epidemic  of  temperance 
was  attested  by  the  statement  of  the  Chief  Secretary,  in 
1840,  that  "the  duties  of  the  military  and  police  in  Ireland 
are  now  almost  entirely  confined  to  keeping  the  ground 
clear  for  the  operation  of  Father  Mathew." 

Though  this  great  wave  of  sobriety  has  gradually 
receded,  till  now  the  extent  of  drinking  in  Erin  is  simply 
terrible,  I  am  every  now  and  again  meeting  professionally 
with  sons  and  daughters  of  Hibernia,  who  glory  in  their 
steadfastness  to  the  pledge  which  they  so  long  ago  took  at 
the  hands  of  the  Irish  apostle  of  temperance.  An  accurate 
study  of  this  unique  crusade  would,  in  psychological 
results,  amply  repay  the  labors  of  any  earnest  student  of 
mental  science. 

Curious  to  relate,  the  other  series  of  inebrio-psychologi- 
cal  phenomena  is  an  experience  in  an  opposite  direction — an 
experiment,  so  to  speak,  not,  as  in  the  former  case,  in  tem- 
perance, but  in  intemperance. 

347 


348  DISEASES    OF   INEBRIETY. 

The  disease  of  inebriety  or  narcomania  (a  mania  for 
intoxication  by  any  kind  of  narcotic  or  anaesthetic),  may 
besides  other  phases,  assume  a  form  correspondent  to  the 
particular  inebriating  substance.  It  may,  therefore,  be 
interesting  to  glance  at  the  origin  and  growth  of  this  new 
mode  of  inebriate  indulgence,  as  this  is  the  first  opportu- 
nity afforded  to  us  of  observing  the  rise  and  progress  of 
such  a  process  in  a  community. 

The  centre  from  which  etlier  drinking  spread  was  the 
town  of  Draperstown  (with  a  population  of  some  300),  in  the 
southern  part  of  the  County  of  Londonderry.  Before  Father 
Mathew's  abstinence  propaganda,  etiier  drinking  was  there 
unknown.  Between  1842  and  1845  a  local  medical  practi- 
tioner, in  response  to  a  request  from  a  few  newly-pledged 
abstaining  converts  for  something  tlie  taking  of  which  would 
not  violate  their  vow,  gave  them  a  drachm  of  ether  in  water. 
So  far  as  I  can  ascertain,  this  was  the /o/is  et  origo  viali.  A 
desire  for  more  frequent  doses  grew  upon  the  ether  drink- 
ers, and  the  practice  spread  in  and  around  Draperstown  till 
there  was  a  shop  for  the  sale  of  ether,  in  one  town,  to  every 
twenty-three  of  the  population.  In  the  session  of  1855-6,  an 
Act  was  passed  by  the  British  Legislature  allowing  spirits 
of  wine  to  be  used  dutv-free  in  arts  and  manufactures 
provided  it  was  made  nasty  as  a  drink  (which  the  Govern- 
ment, in  their  innocence,  supposed  would  prevent  people 
from  drinking  it)  by  the  addition  of  a  minimum  1-9  of  methy- 
lated spirit.  As  ether  prepared  in  this  way  is  much  cheaper 
than  ordinary  sulphuric  ether,  this  cheap  production  of 
"methylated  ether  "  caused  the  consumption  to  increase 
**  by  leaps  and  bounds." 

The  present  ether  area  was,  from  its  mountainous  fea- 
tures, a  central  locality  for  the  illicit  distillation  of  whiskey. 
Owing  to  the  activity  of  the  police  and  the  making  of  roads, 
this  illicit  traffic  was  effectually  stamped  out.  The  disap- 
pointed cheap  whiskey  drinkers  found  a  cheap  unintoxicant 
in  ether.     Mr.   H.  N.  Draper  first  called  attention   to  Irish 


ETHER     INEBRIETY.  349 

ether  drinking  in   1877,  followed  by  Dr.  B,  W.  Richardson, 
about  1879,  and  by  Mr.  Ernest  Hart  in  1890. 

Ether  drinking  was  in  a  year  or  so  gradually  introduced 
from  Draperstown  into  the  neighboring  town  of  Mtighera, 
and  soon  extended  its  sway  till  it  occupied  an  area  of  some- 
where about  295  square  miles,  with  a  population  of  nearly 
79,000  souls.  This  area  may,  in  general  terms,  be  said  to 
comprise  the  mountainous  districts,  especially  of  Derry  and 
Tyrone,  and  to  some  extent,  of  Armagh  and  Antrim. 
Cases  of  ether  intoxication  have  occurred  in  Dublin  and 
ottier  parts  of  Ireland,  in  Glasgow  (Scotland),  in  Lincoln- 
shire in  England,  and  I  have  seen  several  in  London. 

All  the  cases  which  I  have  seen  in  England  have  been 
persons  of  education  and  refinement,  who  had  first  been  al- 
cholic  inebriates  and  gradually  developed  into  devotees  of 
these  twin  poisons.  Nearly  all  of  these  English  cases  have 
been  females,  the  only  males  having  been  members  of  the 
medical  profession.  In  Ireland,  women  assert  the  equality 
of  the  sexes  by  taking  their  fair  share  of  this  form  of  intem- 
perance. Small  farmers  and  agricultural  laborers  make  up 
the  bulk  of  the  Irish  ether  tipplers.  Workmen,  too,  are 
well  to  the  front.  But  the  practice  is  by  no  means  confined 
to  these  classes.  Members  of  the  learned  professions  have 
their  representatives.  Etherists  are  to  be  found  at  almost 
all  ages  from  puberty  onwards.  Sturdy  Irish  lads  and 
beautiful  Irish  lasses,  brimful  of  Hibernian  wit,  as  well  as 
"60-year  olds"  of  both  sexes,  are  slaves  to  ether  drunken- 
ness. The  mother  may  be  seen  with  her  daughters,  and 
maybe  a  neighboring  Irishwoman  or  two,  at  a  friendly  ether 
"  bee."  The  habit  has  become  so  general  that  small  shop- 
keepers treat  the  children  who  have  been  sent  to  purchase 
some  article,  with  a  small  dose  of  ether,  and  schoolmasters 
have  detected  ether  on  the  breaths  of  children  from  10  to 
14  (or  even  younger),  on  their  arrival  at  school. 

Some  critics  have  endeavored  to  lay  the  blame  of  this 
new    development    of   inebriety    on    the    Roman    Catholic 


350  DISEASES    OF   INEBRIETY. 

religion.  Nothing  could  be  more  unwarrantable  and 
unfair.  The  disease  has  spread  principally  among  Roman 
Catholics,  simply  because  this  is  the  creed  of  the  greater 
part  of  the  population.  One  Protestant  village,  Tobermore 
is  as  bad  as  any  other  place.  All  my  cases  have  been  Prot- 
estants. 

The  amount  swallowed  at  a  draught  varies  mainly  with 
the  stage  of  education  in  ether  consumption.  A  novice 
will  find  a  drachm  (a  teaspoonful)  sufficient.  Gradually 
the  wished-for  effect  demands  an  increased  dose,  till  X  of 
an  oz.  may  in  time  become  the  ordinary  "peg"  of  an 
accomplished  drinker,  to  use  the  phraseology  of  Anglo- 
Indians.  These  are  average  quantities  of  a  so-call5d 
"moderate"  drinker.  More  ''seasoned  casks"  have  a 
higher  capacity,  many  toping  off  a  half  a  wineglassful  as 
unconcernedly  as  an  average  Englishman  would  drink  a 
glass  of  claret,  or  an  average  American  a  glass  of  cham- 
pagne. 

The  amount  of  ether  consumed  in  a  day  is  often  remark- 
able. A  confirmed  ether  inebriate  will  take  a  much  larger 
dose  than  any  I  have  just  enumerated,  and  repeat  the  dose 
three,  four,  five,  or  even  six  times  in  the  twenty-four  hours, 
when  "  on  the  spree."  Indeed,  in  some  cases,  half  a  pint 
has  been  the  regular  daily  allowance  of  constant  (or  habit- 
ual) inebriates.  In  England  I  have  known  an  ether  inebri- 
ate use  a  pint  of  ether  by  inhalation  every  day.  In  Ireland, 
many  persons  keep  themselves  intoxicated  pretty  well  dur- 
ing the  day  for  the  sum  of  sixpence — taking  two  penny- 
worth at  lo  o'clock,  I  o'clock  and  4  o'clock.  What  a  para- 
dise for  drunkards  !  Drunk  three  times  a  day  for  13 
cents  ! 

In  England,  in  my  own  practice,  the  majority  of  ether 
drinkers  have  inhaled  the  poison.  In  Ireland  the  universal 
method  is  drinking.  By  the  latter  mode  the  ether  is  taken 
"neat."  Owing  to  an  idea  that  ether,  like  whiskey  or 
brandy,  should  be  drunk  diluted  with  water  to  sheathe  the 


ETHEK     INEBRIETY.  351 

virulence  of  the  poison,  the  uninitiated  and  ignorant  Eng- 
lisliman,  when  in  Ireland,  sometimes  mixes  his  ether  "  peg" 
with  water,  "just  to  try  the  stuff,  you  know."  Ludicrous 
failure  awaits  him,  for,  unlike  ardent  spirits,  ether  is  but 
sparingly  soluble  in  water.  The  pungency  of  ether,  except 
to  those  who  have  "finished  their  education,"  generally  calls 
for  an  "overture"  to  the  "act"  of  ether  swallowing. 
Scene  I. — The  mouth  is  washed  out  with  cold  water. 
Scene  II. — A  draught  of  cold  water  is  drunk.  Scene  III. — 
The  ether  is  swallowed  "  neat."  Scene  IV. — The  perform- 
ance closes  with  a  second  and  final  drink  of  cold  water. 

The  preliminary  draughts  of  water  are  to  cool  the 
mouth  and  throat,  and  the  post-ether  draught  is  "  to  keep 
the  ether  from  rising."  The  washing  of  the  mouth  is  soon 
omitted.  By-and-by  the  preliminary  draught  of  water 
follows  the  same  fate,  the  ether  dose  and  the  succeeding 
draught  of  water  being  the  commonest  method.  As  his 
education  advances,  the  etherist  dispenses  with  water  alto- 
gether. He  may  for  a  while,  especially  when  drinking  an 
unusually  large  dose,  hold  his  nose  with  one  hand,  but 
probably  ends  by  despising  all  precautionary  safeguards, 
and  by  simply  drinking  his  mouthful  of  ether  at  a  gulp. 

Ether purus  of  the  British  Pharmacopoeia  was  at  one 
time  affected  by  my  inebriate  patients.  This  pure  ether 
(02^15)20,  which  is  free  from  alcohol  and  water,  has  been  in 
my  hands  the  only  ether  preparation  which  has  proved  tO' 
be  without  complicatory  drawbacks  when  used  as  an 
anaesthetic  (Brit.  Pharmacopoeia,  720  ;  U.  S.,  725).  Ether 
of  the  B.  P.  (sulphuric  ether)  was,  however,  the  article  gen- 
erally used  for  purposes  of  intoxication.  It  contains  8  per 
cent,  of  alcohol  and  water  with  92  per  cent,  of  ether  purus  ^ 
and  is  soluble  in  all  proportions  with  rectified  spirit,  but  in 
only  I  in  10  with  water.  The  specific  gravity  should  be 
(B.  P.)  .735  ;  (U.  S.)  .750.  It  is  a  swift,  potent,  diffusible 
stimulant,  narcotic,  anaesthetic  and  antispasmodic,  of  great 


352  DISEASES   OF    INEBRIETY. 

value  in  medicine.  It  has  a  strong,  penetrating  odor,  is 
sweetish,  hot,  burning  and  pungent  to  the  palate. 

To  America  the  whole  world  owes  a  deep  debt  of  grati- 
tude for  ^he  introduction  of  ether  as  an  anaesthetic  by  Dr. 
Morton,  in  Boston,  in  1846,  and  any  saddening  misuse  of 
this  grand  mode  of  alleviatiug  human  suffering  ought  not 
to  lessen  our  appreciation  of  tliis  splendid  boon  to  humanity. 

By  the  Act  18  and  19  Vict.,  the  use  of  spirit  of  wine,  free 
of  duty,  was  permitted  in  the  arts  and  manufactures,  on  the 
addition  of  a  minimum  of  1-9  of  wood-naphtha  (methylic 
alcohol  or  spirit  from  the  destructive  distillation  of  wood, 
after  rectification  ;  specific  gravity  .803  B.  P.)  with  a  view 
to  prevent  this  fouled  liquid  from  being  drunk  as  a  bever- 
age. Ether  prepared  from  this  fouled  duty-free  spirit  is,  of 
course,  much  cheaper  than  ether  prepared  from  spirit  of 
wine  on  which  duty  has  to  be  paid.  Tlie  intention,  how- 
ever, was  defeated,  inasmuch  as  in  the  process  of  manufac- 
ture of  ether  from  the  fouled  spirit,  the  fouling  ingredients 
(/.  e.,  the  methyl  products)  are  destroyed.  Thus,  contrary 
to  tlie  general  belief  in  what  is  commonly  called  "methyl- 
ated ether"  being  as  nasty  as  the  methylated  spirit  which 
is  used  for  lamps  and  for  polishing  purposes,  "  methylated 
ether"  is  to  the  taste  hardly  discernible  from  pure  sulphuric 
ether.  This  so-called  "  methylated  ether "  is  practically 
undistinguishable  from  ether  (B.  P.)  at  the  specific  gravity 
of  .717, /.  ^.,  when  purified.  At  any  other  specific  gravit}'^,  an 
odor  is  given  off  after  evaporation.  Practically,  one  cannot 
discriminate  between  the  ethylic  and   methylic  productions. 

Price. — The  ether  thus  prepared  from  the  duty-free  spirit 
(sp.  vin.  rect.  cum  methylic  alcohol),  can  be  produced  at  as 
low  as  one-seventh  of  the  cost  of  ether  prepared  from  the 
duty-paid  spirit,  the  latter  being  bought  wholesale  at  $1.25 
per  lb.,  and  the  former  at  as  low  as  16  cents. 

Ether  is  imported  mostly  from  England,  partly  from 
Scotland,  by  larger  chemists  and  druggists  in  the  principal 
towns    of    Cookstown,    Magherafelt,    and    Maghera.      The 


ETHER   INEBKIETY.  353 

large  dealers  supply  small  shopkeepers,  and  also  cottagers, 
who  sell  in  "drauglits  "  (rather  less  than  2  teaspooiifuls)  for 
one  penny.  Tlie  small  shopkeepers  also  supply  the  hawkers 
(who  are  very  often  women),  who  attend  fairs  and  other 
festive  gatherings  to  dispense  the  "draughts"  of  the  liquid 
poison.  These  "draughts"  are  also  to  be  had  from  the 
surgeries  of  some  medical  practitioners,  and  in  cottages  or 
ether  shebeen,  where  the  cottager  keeps  a  pig  or  two,  and 
sells  ether,  the  country  people  frequently  giving  potatoes, 
meal,  or  other  produce  in  exchange.  Tlie  hawkers  carry 
about  a  bottle  of  ether,  and  do  not  scruple  at  selling  to  any 
one,  however  young,  bartering  a  little  for  one  or  two  eggs. 
In  this  way  the  children  may  procure  the  ether  on  their 
way  to  scliool. 

Intoxication  by  ether  presents  one  distinguishing  feature 
as  compared  with  alcoholic  intoxication.  Tlie  phenomena 
are  practically  alike,  but  in  rapidity  of  manifestation,  alcoiiol 
is  "  nowhere."  Indeed,  in  this  respect,  ether  beats  the 
record.  There  is  the  exhilarative  stage  of  morbid  exalta- 
tion, when  the  fun  and  exuberant  merriment,  the  latent  and 
ineradicable  impulse  of  one  "  spoiling  for  a  fight  "  of  the 
genuine  Irishman  stands  revealed  in  the  twinkle  of  the 
eye,  and  the  flourish  of  the  shillelagh.  The  pleasing  but 
quickly  vanishing  whirl  of  enjoyment  is  followed  by  an 
evanescent  episode  of  brain  disturbance  and  mental  riot, 
with  muscular  paralysis  and  incoordination.  To  these 
succeeds  the  concluding  comatose  stage,  when  the  patient 
is  said  to  be  "  dead  drunk."  The  shortest  period  in  which 
I  have  seen  this  inebriate  panorama  move  on  till  it  swung 
round  to  recovered  sobriety  has,  with  alcohol,  been  six 
hours.  With  ether,  I  have  witnessed  the  entire  revolution 
in  less  than  two  hours. 

In  my  observation  an  alcoholic  inebriate  career,  from 
start  to  a  fatal  finish,  has  in  America  been,  on  an  average, 
one-third  of  the  duration  of  a  corresponding  career  in 
Britain.      So,  curious    to   say,  has  the    length  of   an   ether 


354  DISEASES    OF   INEBRIETY. 

intoxicative  paroxysm  been  one-third  the  length  of  an 
alcoholic  intoxicative  paroxysm.  Thus  the  etherist  can 
have  three  thorough  "drunks  "for  one  of  the  alcoholist. 
Herein,  in  addition  to  the  greater  cheapness,  lies  the  supe- 
rior claim  of  ether  to  the  "  greedy  for  intoxication,"  the  true 
"  narcomaniac." 

Intoxication  by  ether  may  be  described  as  "hysterical," 
and  intoxication  by  ether  ^«;;/ alcohol  as  "maniacal."  A 
man  arrested  while  drunk  on  ether  alone,  would  probably 
be  quite  sober  by  the  time  the  constable  had  him  at  the 
police  station,  which  might  be  very  awkward  for  the  con- 
stable, though  the  arrest  had  been  made  when  the  man  was 
in  a  frenzy  of  boisterous  excitement.  Several  deaths  from 
ether,  and  ether  cunt  alcohol,  have  occurred. 

Little  is  known  of  the  pathology  of  ether.  The  habit 
has  been  too  young  to  afford  opportunities  of  much  post- 
mortem examination  of  ether  inebriates.  Premature  old  age, 
an  antedated  shriveling  up  of  the  living  frame,  attests  the 
poisonous  influence  of  the  destroying  agent.  Gastritis 
(acute  and  chronic),  debility,  dyspeptic  distress,  epigastric 
pain,  pallors,  tremors,  timidity,  moroseness,  suspicion,  nerv- 
ous prostration,  chilliness,  a  cyanosed  or  lemon  skin,  and 
an  intermitting  heart-beat,  with  exaggerated  reflexes,  are 
prominent  symptoms.  I  have  one  such  victim  in  my  mind's 
eye  now.  Fawning,  cunning,  terror-stricken,  this  wretched 
medical  colleague  is  the  incarnation  of  utter  misery.  Not 
yet  40  years  of  age,  he  shuffles  about  like  a  worn-out  old 
man  of  90  after  a  wasted  and  mis-spent  life.  It  has  been 
urged  by  some  medical  authorities  that  ether  is  guiltless  of 
producing  any  pathological  lesion,  from  the  almost  light- 
ning rapidity  with  which  its  inebriating  manifestations 
appear  and  fade  away,  and  from  no  serious  morbid  after- 
death  appearances  having  been  observed. 

This  conclusion  is,  in  my  judgment,  premature.  Judg- 
ing from  the  symptoms  from  which  I  have  seen  ether 
inebriates   suffer,  I   have   not  the  slightest  doubt  that  ether 


ETHEK     INEBRIETY.  355 

has  a  pathological  influence  on  various  organs  and  tissues, 
and  that,  if  ether  drinking  could  boast  of  as  venerable  an 
antiquity  as  alcohol  drinking,  unmistakable  lesions  would 
have  been  but  too  manifest.  Wliat  are  the  forty  years  of 
ether  consumption  by  a  hundred  thousand  persons,  to  the 
thousands  of  years  of  alcohol  consumption  by  at  least  as 
many  millions  of  human  beings  ? 

Happily,  this  new  form  of  inebriation  is  but  in  its 
infancy,  so  there  is  some  hope  that  its  growth  may  be 
"  nipped  in  the  bud."  As,  in  the  conversion  of  methylated 
spirit  into  ether,  the  nauseous  methyl  products  are 
destroyed,  something  might  be  done  towards  making  the 
liquor  loathsome  to  the  palate  by  the  compulsory  addition 
of  the  wood  spirit  after  the  completion  of  the  etherification 
before  the  sale  of  the  liquid.  This,  however,  would  be  but 
a  palliative,  for  I  have  had  patients  under  my  care  who 
drank  methylated  spirit  (some  even  from  jars  with  anatom- 
ical preparations)  and  in  Edinburgh  and  Glasgow,  Sun- 
day drinking  of  tiiis  nasty  beverage  recently  flourished 
apace.  In  a  certain  locality  in  the  north  of  Ireland,  the 
drinking  of  methylated  spirit  was  introduced  seven  or 
eight  years  ago.  At  first  confined  to  the  very  poor  in  a 
hilly  district,  it  has  spread  rapidly,  till  now  farm  laborers 
and  farmers  are  daily  indulging  in  it, 

Tliere  are  many  inebriates  who  hate  and  abhor  the  taste 
of  the  intoxicant  which,  in  their  narcomaniac  madness,  they 
would  barter  their  salvation  to  procure. 

Another  remedy  would  be  the  abolition  of  the  retail 
sale.  This  would  help  by  putting  difficulties  in  the  way  of 
the  drinker,  but  would  only  mitigate  the  mischief.  Still 
more  effectual  would  be  the  scheduling  of  ether  as  a  poison, 
the  sale  of  which  is  restricted  to  druggists  under  certain 
safeguards.  This  course  was  so  readily  adopted  for  Ireland 
by  the  British  government  in  January  last,  that  I  have  j'et 
hope  the  dav  will  come  when  the  more  deadly  allied  poi- 
son— alcohol — will  be  placed  in    the  same  category,  and  so 


356  DISEASES    OF   INEBRIETY. 

dangerous  a  drug  vviVl  be  relegated  to  the  shelf  of  the 
apothecar}'',  its  sale  hedged  in  with  as  stringent  precautions 
as  is  now  the  sale  of  arsenic  or  prussic  acid.  But  tliis  hal- 
cyon era  of  prohibition  will  only  be  attained  after  a  pro- 
longed struggle,  amid  the  howls  and  groans  of  an  enraged 
liquordom,  whose  indignation  is  concentrated  on  all  who 
attempt  to  "  rob  a  poor  man  of  his  beer."' 

It  is  too  soon  yet  to  foretell  the  ultimate  result  of  the 
bold  step  taken  by  our  Government  in  scheduling  ether  as 
a  poison,  but  it  has  made  the  procuring  of  ether  for  drink- 
ing purposes  so  difficult  that  for  the  present  the  sale  lias 
diminished  by  at  least  75  per  cent.  I  fear,  however,  that 
the  cupidity  of  some  wlioiesale  dealers  will  incite  them  to 
risk  the  penalties  of  the  law  by  surreptitious  sales,  which 
will  speedily  be  ferreted  out  by  the  marvelous  cunning  of 
the  diseased  and  demoralized  inebriate. 

The  lines  of  sound  treatment  of  ether  inebriety,  and  of 
its  prevention  by  law,  must  alike  be  based  on  an  intelligent 
appreciation  of  the  true  character  and  etiology  of  ether 
drunkenness.  This  is,  in  reality,  but  a  new  manifestation  of 
an  underlying  morbid  condition  which  renders  certain  of 
the  sons  and  daughters  of  men  peculiarly  liable  to  plunge 
into  intoxication.  We  can  never  hope  to  succeed  in  the 
cure  and  prevention  of  any  disease,  until  we  first  recognize 
the  presence  of  tiie  disease  itself.  The  malady  of  narcoma- 
nia, as  subtle  as  it  is  far-reaching  in  its  influence  on  body, 
brain  and  mind,  and  morals,  is  a  legitimate  outcome  of 
natural  law,  and  we  will  not  be  adequately  equipped  for 
the  fight  till  we  are  thoroughly  conversant  with  the  laws 
under  which  every  form  of  the  disease  of  inebriety  is 
developed  and  propagated. 


CHAPTER  XXXIV. 

COCAINE    INEBRIETY. 

The  dangers  to  be  apprehended  from  the  abuse  of 
cocaine  are  probably  hardly  yet  quite  realized,  at  least  in  this 
country.  A  great  deal  of  harm  has  undoubtedly  been  done 
of  recent  years  by  the  use  of  cocaine  as  a  help  to  break  off 
the  morphia  habit.  An  exaggerated  estimate  of  the  assist- 
ance to  be  obtained  from  the  former  drug  has  been  formed 
by  such  writers  as  Freund,  and  although  Elwin  and  Erlen- 
meyer  have  warned  us  not  to  fly  from  Scylla  to  Charybdis, 
still  it  is  to  be  feared  that  the  notion  lingers  that  cocaine 
may  be  used  advantageously  and  safely  for  this  purpose. 
Nothing  can  be  more  mistaken.  Cocaine  is  more  seductive 
than  morphia.  It  fastens  upon  its  victim  more  rapidly, 
and  its  hold  is,  at  least,  as  tight.  Cocaine  solutions  are 
probably  somewhat  too  freely  prescribed  in  cases  of  diseases 
of  the  nose  and  naso-pharynx.  Patients  who  use  the  drug 
in  this  way  become  very  soon  acquainted  with  its  agreeable 
effects.  Several  cases  have  been  recorded  by  American 
authors  of  cocaine  habit  arising  thus.  That  cocaine  has 
not  been  even  more  extensively  misused  is  probably  due  to 
its  being  still  a  comparatively  new  drug,  and  also  in  part  to 
its  costliness.  Up  to  the  present  time  the  largest  number 
of  its  victims  appear,  unfortunately,  to  have  been  medical 
men. 

Cocaine  owes  its  special  dangers  to  three  causes.  First, 
it  is  particularly  treacherous.  Secondly,  it  produces  early 
mental  breakdown  both  in  the  moral  and  intellectual  spheres. 
Thirdly,  it  is  intensely  toxic,  bringing  about  destructive  tis- 

357 


358  DISEASES   OF   INEBRIETY. 

sue  clianges  after  a  comparatively  short  period  of  abuse. 
Taking  the  last  first,  we  know  tliat  aicoliolic  poisoning  is 
usually  a  slow  process,  while  morphia  may  be  taken  even  in 
very  large  quantities  for  years  without  producing  any  serious 
structural  changes  in  the  nerves.  In  fact,' we  recognize  no 
distinct  pathological  results  of  morphia  poisoning.  On  the 
other  hand,  the  marasmus  of  chronic  cocaine  poisoning, 
appearing  early  and  developing  with  extreme  rapidity,  is 
but  one  indication  of  the  serious  organic  changes  that  are 
produced.  Convulsions  similar,  as  Richet  points  out,  to 
those  of  cortical  epilepsy,  have  been  noted  in  a  great  number 
of  cases.  In  at  least  one  recorded  case,  death  occurred  in 
an  epileptiform  attack.  In  animals,  poisoned  with  cocaine, 
remarkable  rise  of  temperature  has  been  observed  by  Mosso 
Reichert  and  otiiers.  Acute  poisoning  in  animals  kills  by 
asphyxia  ;  clironic  poisoning,  as  Zanclievski  shows,  is  accom- 
panied by  albuminous  degeneration  of  the  ganglionic  cells 
in  the  medulla  oblongata  and  spinal  cord,  as  well  as  of  the 
nerve  cells  of  the  heart  ganglia  and  of  the  liver  cells.  In 
other  more  advanced  cases  this  author  has  found  atrophic 
changes  with  vacuolation  in  the  cells  of  the  medulla  and 
cord,  fatty  degeneration  of  the  muscular  fibres  of  the  heart, 
and  atrophy  of  the  liver  cells.  Degenerative  changes  also 
occurred  in  the  arterial  coats,  particularly  in  the  spinal  cord 
Perhaps  organic  changes  similar,  but  less  in  degree,  account 
for  the  slowness  and  difficulty  in  recovering  from  the  cocaine 
habit,  and  the  liability  to  dangerous  collapse  which  exists 
during  the  process  of  withdrawing  the  drug. 

The  treacherous  and  insidious  character  of  cocaine 
results  from  the  fact  that  when  taken  in  small  doses  it  pro- 
duces at  first  apparently  nothing  but  a  slight  degree  of  ex- 
altation, a  sense  of  well  being,  a  feeling  of  mutual  and  bodily 
activity,  of  general  satisfaction  and  of  good  humor  that  is 
most  agreeable.  There  is  no  mental  confusion  which  the 
consumer  of  cocaine  is  conscious  of,  and  the  only  overt 
symptoms  he  betrays    at  this    stage  is   more    than  natural 


COCAINE   INEBRIETY.  359 

talkativeness.  The  hypnotic  effects,  when  they  appear,  are 
not  overwhelming,  and  there  is  no  headache,  no  nausea,  no 
confusion  next  day.  This  cocaine  is  probably  the  most 
agreeable  of  all  narcotics,  therefore  the  most  dangerous  and 
alluring.  It  is  to  be  feared  that  these  peculiar  qualities  may, 
indeed,  conduce  to  raise  this  drug  in  the  future  to  the  bad 
eminence  of  being  as  Erlenmeyer  says,  the  third  great 
scourge  of  the  human  race  (alcohol  and  opium  being  the 
first  and  second).  Like  several  other  observers,  I  have  sat- 
isfied myself  by  experiments  on  healthy  persons,  that  the 
agreeable  results  described  actually  follow  the  ingestion  of 
small  doses  of  cocaine,  and  this  fact  impresses  one  strongly 
with  the  feeling  of  how  seductive  this  drug  would  be  to  the 
neurotic  or  debilitated.  Of  course,  as  is  the  case  with  all 
narcotics,  small  doses  soon  lose  their  effect,  and  hence  a 
rapid  increase  is  necessary. 

The  rapidity  with  which  mental  symptoms  of  a  grave 
character  appear  is  remarkable  in  cases  in  which  increasing 
quantities  of  cocaine  are  taken.  Within  three  months 
marked  indications  of  degeneration,  loss  of  memory,  hallu- 
cinations,and  suspicion  deepening  into  persecutory  delusions 
have  been  found. 

The  following  is  a  characteristic  clinical  picture  :  on  the 
one  side  in  the  cachexia  or  bodily  ruin,  on  the  other  side  in 
the  moral  impairment  and  pronounced  mental  affection. 
Patients  who  use  cocaine  alone — and  those  who  have  endeav- 
ored to  wean  themselves  from  morphine  by  its  aid,  and  so 
added  cocainism  to  the  morphine  habit — appear  marasmatic. 
The  skin  is  of  a  pale  yellowish,  almost  cadaveric  tint  and 
withered  feel  ;  the  extremities  are  cool  and  covered  with 
cold  sweat.  The  eyes  are  deeply  sunken,  glistening,  and 
surrounded  by  a  dark  ring  ;  the  pupils  widely  dilated. 
Appetite  is  lost  ;  digestion  disturbed.  Salivation  with  dry- 
ness of  throat  may  be  complained  of,  and  further,  partial 
sensory  disturbances  or  total  analgesia.  From  the  paralyz- 
ing action  of  cocaine  upon  the  blood-vessels,  patients  com- 


360  DISEASES    OF    INEBKIETY. 

plain  of  palpitation  and  breathlessness,  troublesome  sweat- 
ing and  noises  in  the  ears,  and  also  syncopal  attacks  and 
dyspnoea.  The  pulse  is  more  frequent  and  easily  compres- 
sible. They  suffer  from  a  want  which  must  be  satisfied  ; 
they  become  nervous,  trembling,  and  fall  into  a  wretched 
condition  of  neurasthenia. 

Speech  is  disconnected  and  can  scarcely  be  understood  ; 
impotence  and  incontinence  of  urine  may  appear.  Sleep- 
lessness sets  in  early.  One  of  the  most  characteristic  effects 
of  this  habit  is  the  occurrence  of  muscular  twitching,  tonic 
and  clonic  convulsions,  and  finally  epileptic  attacks  in 
which  the  patient  may  die.  The  mental  symptoms  may 
take  the  form  of  hallucinations,  usually  of  general  sensa- 
tion, but  not  infrequently  of  sight  as  well.  General  mental 
weakness  may  set  in  rather  early,  to  be  observed  in  a  loss  of 
memory  and  unusual  prolixity  in  conversation  and  corres- 
pondence. When  the  drug  is  withdrawn,  besides  the  vaso- 
motor symptoms  there  may  be  seen  depression,  impairment 
of  will-power,  weeping,  etc.  The  chronic  form  does  not 
protect  from  acute  intoxication. 

The  treatment  of  a  cocaine  inebriate  is  practically  the 
same  as  that  of  opium  and  alcohol  cases.  There  is  a  degree 
of  brain-degeneration  apparent  in  the  morbid  impulses 
and  strange,  uncertain  mental  action  of  these  cases  that 
approaches  very  near  to  insanity.  Abrupt  withdrawal  of  the 
drug  is  the  safest  plan,  and  reliance  is  to  be  placed  on 
bromides,  foods,  and  baths  to  relieve  the  irritation  and 
depression  which  follow.  In  the  method  of  gradual  with- 
drawal it  has  been  found  that  small  doses  may  result  in 
collapse.  In  one  case,  in  which  lo  grains  a  day  had  been 
previously  taken,  and  by  gradual  withdrawal  the  amount 
had  reached  3  grains,  symptoms  of  heart  failure  and  paral- 
ysis suddenly  came  on.  The  dose  was  increased  and  the 
patient  recovered.  In  another  case,  complicated  with 
alcoholism,  the  daily  allowance  of  7  grains  was  reduced  to 
4,  when  a  violent  collapse  set  in,  which  was  cliecked  by  giv- 


COCAINE   INEBRIETY.  361 

ing  the  usual  dose.  The  case  finally  became  an  alcoholic, 
but  eventually  recovered.  The  treatment  of  these  mixed 
cases  requires  great  care  and  watching,  as  they  are 
especially  liable  to  fatal  collapse  or  to  develop  some  form 
of  acute  brain  disease. 

Strychnine  and  the  mineral  acids  are  useful.  Because 
of  its  rapid  stimulant  action  strychnine,  given  hypodermi- 
cally,  1-40  grain  every  three  hours,  will  often  prevent  col- 
lapse when  the  cocaine  is  withdrawn.  Mineral  acids,  chiefly 
phosphoric,  may  be  given  in  i  drachm  doses  three  times  a 
day  as  a  general  tonic,  unless  contraindicated  by  an  acid 
stomach.  In  these  cases  mental  conditions  approaching 
delirium  are  present.  The  functional  disturbance  of  the  heart 
and  the  emotional  changes  that  are  so  prominent  in  the 
latest  stages,  and  the  uncertain  co-ordination  of  both  the 
higiier  and  lower  brain  and  nerve-centres,  all  indicate  the 
most  serious  disturbance.  Some  of  the  forms  of  iron, 
quinine,  and  strychnine  may  be  very  useful  at  the  beginning 
of  the  treatment.  Water  containing  bromide  of  sodium,  40 
grains  to  the  ounce,  and  charged  with  gas,  can  be  given 
freely  for  some  time  with  good  results. 

The  therapeutics  must  be  governed  by  the  conditions  of 
the  case.  AH  cases  should  be  treated  in  an  asylum,  wliere 
the  physician  can  have  the  full  control  of  the  conditions 
and  surroundings  of  the  patient.  Home  treatment  is  dififi- 
cultand  unsatisfactory.  The  patient  is  always  hypersensitive 
to  pain  and  suffering,  and  will  use  deception  and  intrigue 
t©  avoid  it.  The  will-power  is  of  no  assistance,  and  the 
success  of  treatment  will  depend  on  accurate  study  and 
observation  of  the  case.  Drugs  are  of  little  value  ;  foods 
and  hygienic  care,  including  baths,  will  give  the  best  results. 

In  all  chronic  drug-maniacs  the  pliysician  should  be  on 
the  lookout  for  cocainism.  When  cocainism  is  present  a 
sudden  addiction  to  opium,  alcohol,  chloral,  or  chloroform 
may  arise,  and  in  all  cases  the  piiysician  should  be  prepared 
for  a  sudden  fatal  termination  of  the  case  at  anv  time. 


CHAPTER   XXXV. 

CHLOROFORM   INEBRIETY. 

The  following  history  of  a  case  is  so  graphic  and  full  of 
suggestions  as  to  give  the  reader  a  good  idea  of  sucli  cases. 
He  says  :  "With  me  the  chloroform  infatuation  was  a 
case  of  love  at  first  sight.  I  had  been  always  temperate, 
almost  a  total  abstainer  from  stimulants  of  all  kinds.  Once 
or  twice  I  had  smelled  chloroform,  and  thougiit  its  odor 
pleasant.  I  was  a  young  man  just  finishing  my  education, 
and  fond  of  study.  I  had  had  some  curiosity  to  know  what 
it  was  like  to  be  put  to  sleep  with  chloroform,  and  one  night 
I  happened  to  see  a  one-ounce  bottle  of  chloroform  wiiich 
was  bought  for  the  toothaciie.  I  took  the  bottle  home  with 
me,  and  when  I  went  to  bed  put  a  little  of  the  chloroform 
on  a  handkerchief,  and  for  the  first  time  felt  the  deligiitful 
sensation  of  being  wafted  through  an  enchanted  land  into 
Nirvana.  Those  wiio  know  nothing  of  intoxication,  except 
in  the  vulgar  form  produced  by  whiskey,  have  yet  to  learn 
what  power  there  can  be  in  a  poison  to  create  in  a  moment 
an  Elysium  of  deligiit.  It  is  a  heaven  of  chaste  pleasures. 
What  I  most  remember  is  the  vivid  pictures  that  would 
seem  to  pass  before  my  eyes — creations  of  marvelous  beauty 
— every  image  distinct  in  outline,  perfect  in  symmetry,  and 
brilliant  in  coloring.  The  enjoyment  is  purely  passive  ;  you 
have  only  to  watch  vision  after  vision  ;  but  why  each  vision 
seems  more  wonderful  and  charming  than  the  last  you  can- 
not tell,  and  you  do  not  stop  to  question. 

"I  suppose  that  it  was  an   unfortunate  circumstance  for 
me  that  I    had  never  been  drunk   before  in   my  life,  and  I 

363 


364:  DISEASES    OF    INEBRIETY. 

never  thought  of  comparing  my  blissful  condition  with  that 
of  the  wretches  I  had  sometimes  seen  staggering  through 
the  streets.  I  liad  made  a  great  discovery.  I  iiad  found  a 
golden  gate  into  dreamland — dangerous  indeed  to  approach, 
I  knew  that,  but  who  would  heed  any  danger  where  the 
prize  to  be  obtained  was  so  great  ? — and  guarding  jealously 
my  secret,  I  took  care  night  after  night  to  have  by  me  the 
key  to  tliat  golden  gate.  Probably  I  inhaled  from  half  a 
drachm  to  a  drachm  or  two  each  time.  Generally  I  did 
not  waken  again  until  morning,  and  my  sleep  seemed  to  be 
just  as  refreshing  as  usual,  only  now  and  then  I  would 
wake  with  a  trifling  headache  and  feel  disposed  to  lie  a 
little  longer  in  bed  than  common.  My  bodily  condition 
did  not  seem  to  sufier  in  the  least,  and  my  faculties  all 
seemed  as  keen  as  ever.  I  felt  no  craving  for  my  pet 
intoxicant  during  the  day — did  not  give  it  a  thought  often 
until  bed-time  came,  and  then  it  would  occur  to  me  for  a 
moment  to  try  and  see  how  it  would  seem  to  go  to  sleep  in 
the  ordinary  way,  the  conclusion  always  being  that — 
to-morrow  night  I  would  make  the  experiment.  So,  before 
I  knew  it,  I  was  a  slave.  I  would  say  to  myself,  '  It  does 
not  hurt  me  ;  it  seems  to  have  no  more  effect  than  the  cigar 
my  friend  smokes  after  dinner.  Really  I  believe  it  is  a 
positive  benefit.  It  seems  to  keep  my  bowels  regular,  and 
it  certainly  makes  me  sleep  soundly  all  night.' 

"But  after  a  while  I  found  that  I  was  using  a  larger 
quantity  of  chloroform  than  at  first.  I  would  take  a  two 
ounce  bottle  half-full  of  the  stuff  to  bed  with  me,  and  inhal- 
ing directly  from  the  bottle  would  forget  at  last  to  cork  it, 
and  in  the  morning  it  would  be  empty.  Sometimes  I  would 
wake  after  midnight,  or  partially  wake,  to  take  another 
dose.  I  found  that  there  was  a  bad  taste  in  my  mouth  all 
the  time,  keeping  me  in  mind  of  chloroform.  I  was  often 
nauseated  in  the  morning,  and  sometimes  at  intervals  dur- 
ing the  day.  I  began  to  feel  a  longing  for  chloroform 
whenever   I  had   a  little  headache,  or  was   dispirited    from 


CHLOEOFOKM    INEBEIETT.  365' 

any  cause,  and  I  sometimes  yielded  to  what  I  already  knew 
was  a  morbid  craving.  I  began  to  be  indifferent  to  the 
things  that  personally  had  interested  me,  avoided  society, 
and  became  depressed  in  spirits.  My  complexion  became 
sallow,  whites  of  the  eyes  yellow,  the  bowels  sometimes 
windy  and  unnaturally  loose,  skin  dry  and  seemingly 
bloodless,  and  injuries  of  the  skin  did  not  heal  rapidly. 
In  winter  there  was  a  tendency  to  chapping,  that  had  not 
before  been   noticed, 

"  Meanwhile  I  had  ceased  to  have  visions,  or  they  came 
rarely.  I  began  to  realize  that  my  pet  habit  was  becoming 
my  tyrannical  master.  I  had  no  special  cares  to  drown,  but 
it  became  my  insane  pleasure  to  draw  over  my  senses  the 
veil  of  oblivion.  I  loved  the  valley  of  the  shadow  of  death. 
I  knew  there  was  danger  that  some  night  I  should  pass  over 
the  line,  into  a  sleep  from  which  there  would  be  no  waking  ; 
but  death  had  no  terrors  for  me.  Nay,  to  bring  all  my 
faculties  and  powers  and  ambitions  into  tlie  sweet  oblivion 
of  transient  death  was  the  one  pleasure  for  which  I  cared  to 
live.  I  was  conscious  of  a  profound  moral  deterioration  ;  I 
became  materialist  ;  I  had  no  soul  ;  immortality  was  a 
dream  of  the  ignorant  ;  I,  who  had  a  thousand  times  anni- 
hilated my  own  soul  with  my  senses,  knew  that  the  dream 
had  no  corresponding  reality. 

**  Yet  all  this  time  I  continued  faithful  in  my  daily  duties, 
and  resisted  successfully  the  temptation  to  hurry  through 
my  evening  so  as  to  get  the  sooner  to  my  chloroform,  I 
did  not  admit  to  myself  that  I  was  a  slave  to  the  habit,  or 
even  that  the  habit  was  an  injury  to  me,  as  yet ;  but  I 
began  to  be  afraid,  and  the  more  when  I  found,  when  I 
resolved  (as  often  I  did),  to  omit  my  nightly  indulgence, 
just  for  a  week,  how  impotent  my  will  was  in  the  matter, 

"This  was  my  condition  at  the  end  of  two  years.  I  was 
still  only  using  a  moderate  quantity  of  chloroform,  about 
three  drachms  daily,  exceeding  that  quantity  only  by  acci- 
dent.    An  opportunity  offered  for  a  change  of  occupation 


366  DISEASES   OF   INEBRIETY. 

and  surroundings,  which  I  eagerly  seized  in  the  hope  that 
it  might  enable  me  to  break  my  fetters.  For  about  three 
months,  under  the  new  surroundings,  I  abstained  from 
chloroform,  and  found  it  really  not  difficult  to  do  so.  I 
began  to  think  that  I  had  greatly  over-rated  the  power  of 
the  habit.  At  all  events,  after  the  first  week  I  had  no  crav- 
ing for  the  stimulant.  But  one  day  I  came  across  a  bottle 
of  chloroform.  When  I  saw  it  I  smiled  to  myself  to  think 
that  I  had  imagined  myself  a  slave  of  any  such  thing. 
Night  came,  and  when  I  was  ready  for  bed  the  devil  of 
appetite  gave  me  his  commands,  and  I  obeyed.  Just  one 
smell  to  see  whether  I  really  wanted  it  ;  I  would  not  take 
the  bottle  to  bed  with  me.  So  I  inhaled,  standing,  directly 
from  the  bottle — a  full  pound  of  chloroform — and  with  the 
first  breath  of  the  vapor  came  back,  with  renewed  force,  all 
the  old  appetite,  keener  than  ever  from  long  abstinence. 
Once  more  I  saw  the  old-time  visions,  as  beautiful  and  as 
vivid  as  at  first.  One  peculiarity  of  these  visions  I  may 
speak  of  right  here.  Objects  would  appear  with  wonderful 
sharpness  of  outline  just  as  they  would  be  seen  with  the 
eyes,  only  reduced  to  micoscopic  size  like  objects  seen 
through  an  inverted  microscope. 

"To  go  on  with  my  story.  What  happened  after  I  got 
the  bottle  in  my  hands  I  do  not  know.  The  next  morning 
I  found  the  bottle  corked  and  in  its  place,  but  only  half 
full  of  chloroform,  and  I  was  told  that  I  had  been  lying  in 
some  kind  of  a  fit ;  some  thought  I  was  drunk — as  indeed  I 
was.  From  this  time  I  realized  myself  a  slave,  but  not 
now  a  willing  one.  I  did  not  again  commence  at  once  the 
use  of  the  chloroform,  but  at  intervals  of  from  three  to 
eight  weeks  would  indulge  in  a  regular  spree,  lasting  from 
one  to  three  days,  during  which  I  would  keep  myself  as 
nearly  as  possible  dead  drunk,  and  would  consume  from 
four  to  eight  ounces  of  chloroform.  All  this  time  I  kept 
my  habit  a  secret,  and  continued  to  do  my  ordinary  work 


CHLOKOFOKM   INEBRIETY.  367 

with  the  usual  zest  in  the  intervals  between  my  sprees.  At 
last  discover)^  came.  You  well  remember  how  I  was  found 
apparently  lifeless,  and  how  by  the  active  use  of  restora- 
tives you  brought  me  to  myself.  How  my  moral  percep- 
tions were  quickened  the  moment  I  saw  myself  througli  the 
eyes  of  another ! 

"  You  know  that  it  was  not  in  a  week  or  a  year  that  I  was 
placed  morally  on  a  firm  foothold  again.  Indeed,  you  did 
not  know  how  often,  after  I  had  given  you  and  myself  my 
word  and  pledge  to  abstain  wholly  from  chloroform,  I 
relapsed,  taken  unawares  by  the  tempter.  For  more  than 
two  years  I  kept  up  the  conflict,  too  often  thinking  the  final 
victory  won,  only  to  find  there  was  one  imperative  command 
it  was  useless  for  me  to  attempt  to  disobey,  and  that  com- 
mand came  to  me  whenever  the  least  whiff  of  chloroform 
entered  my  nostrils.  Once  or  twice  I  tried  tlie  expedient  of 
returning  to  my  first  practice  of  a  regular  moderate  use  of 
the  stimulant,  but  I  found  that  moderation  was  now  almost 
impossible,  if  I  went  to  sleep  under  the  influence  I  would 
awake  again,  and  find  myself  then  unable  to  sleep,  distress- 
ingly wide  awake  and  nervous,  until  I  courted  again  my 
'dearest  foe.'  Symptoms  like  those  of  delirium  tremens 
several  times  developed.  I  saw  '  things,'  not  now  beautiful 
visions,  but  shadowy  images,  that  filled  me  with  nameless, 
irrational  horror.  Appetite  was  capricious.  I  was  fre- 
quently nauseated,  but  food  seemed  to  relieve  this  condi- 
tion ;  vitality  was  low,  the  blood  ran  sluggishly  in  my  veins, 
and  seemed  especially  to  desert  the  surface  of  the  body.  I 
suffered  particularly  in  cold  weather,  and  it  was  during  cold 
weather  in  winter,  especially,  that  I  found  it  almost  impos- 
s-ible  to  resist  my  besetting  temptation. 

"At  last  I  prevailed  by  sheer  force  of  will.  I  had  recov- 
ered enough  faith  in  the  soul  to  assert  my  freedom,  and  I 
now  look  back  upon  those  years  of  conflict  with  a  kind  of 
self-pity,  to  think  I  could  have  been  so  weak.  But  I  do  not 
to-day  court  temptation.     I  am  not  conscious   of  a  lurking 


368  DISEASES    OF   INEBRIETY. 

appetite,  but  I  dare  not  put  my  virtue  to  any  severe  test.  -I 
am  sure,  however,  that  the  chloroform  habit  is  one  that  can 
be  broken  by  steady  determination.  I  have  no  faith  in  any 
process  of  tapering  off.  It  is  just  as  easy  to  quit  once  for 
all  as  to  prolong  the  agony,  and  the  suffering  is  often  purely 
imaginary.  It  took  many  months  for  me  to  recover.  If 
doctors  only  knew  the  fascination  of  this  drug,  they  would 
seldom  or  never  prescribe  it.  The  danger  of  the  wine  cup 
is  nothing  to  that  of  the  chloroform  bottle." 


CHAPTER  XXXVI. 

COFFEE  AND  TEA  INEBRIETY  AND  THEIR  EFFECTS. 

Most  physicians  are  doubtless  able  to  recall  numerous 
instances  in  which  coffee  has  induced  more  or  less  serious 
symptoms.  It  seems  that  personal  idiosyncrasies  often 
determine  the  extent  of  the  evil.  The  evils  upon  the  eyes 
and  ears  of  people  are  more  frequent  from  coffee  than  from 
tobacco  or  alcohol.  It  does  not  absolutely  destroy  vision  or 
hearing,  but  it  induces  functional  troubles  very  annoying  to 
their  possessors.  That  coffee  is  the  efficient  agent  appears 
from  the  fact  that  upon  the  entire  discontinuance  of  the  use 
of  coffee,  the  symptoms  complained  of  disappear. 

Dr.  Guelliot  has  published  twenty-three  cases  of  chronic 
caffeism.     Of  these  cases  seventeen  were  women. 

The  following  are  the  principal  symptoms  : 

Anorexia,  disturbance  of  sleep,  trembling  of  the  lips  and 
tongue,  attacks  of  gastralgia,  different  kinds  of  neuralgia, 
dyspepsia,  and  leucorrhoea,  often  profuse.  In  the  twenty- 
three  cases,  he  found  in  eighteen,  anorexia  ;  in  sixteen, 
disturbance  of  sleep  ;  in  sixteen,  trembling  of  the  lips  and 
tongue  ;  in  twelve,  leucorrhoea  ;  in  eleven,  gastralgia  ;  in 
ten,  dyspepsia  ;  in  ten,  neuralgia  of  various  forms  ;  in  eight, 
cephalalgia  ;  in  four,  vertigo  and  convulsive  attacks  ;  in 
four,  obstinate  constipation  ;  and  in  three,  constipation  and 
diarrhoea  alternating. 

The  patients  had  pinched,  pale,  wrinkled  faces,  a  weak, 
rapid  pulse,  and  the  sleep  was  disturbed  by  anxious  dreams. 
The  following  is  the  account  of  a  typical  case  :  A  woman 

369 


370  DISEASES    OF   INEBRIETY. 

in  middle  life  kept  her  pocket  full  of  coffee,  which  she  ate 
constantly.  Her  skin  was  of  an  earthy  tint,  constipation 
was  obstinate,  sleep  very  irregular,  and  her  mind  restless, 
anxious,  and  full  of  forebodings.  She  wasmucli  emaciated, 
and  both  the  nervous  system  and  digestion  suffered  severely 
at  times.  The  lips  and  tongue  were  tremulous,  dry,  red, 
and  cracked.  The  appetite  was  very  irregular,  and  vertigo, 
prolonged  headache,  and  epigastric  pain  were  present  most 
of  the  time.  She  was  placed  under  treatment  and  became 
delirious.  Beef-tea,  milk,  baths,  and  a  mild  galvanic  current 
were  used  for  several  weeks,  and  these  were  followed  by 
bark  tonics.  She  was  discharged  restored  six  months 
later. 

The  evil  effects  of  coffee  are  especially  observable  in 
children.  Tlie  coffee  drunkard  is  described  as  thin,  pinched 
features,  pale,  wrinkled  face,  and  a  grayish  yellow  complex- 
ion. The  pulse  is  weak,  frequent,  and  compressible.  The 
sleep  is  troubled  with  anxious  dreams. 

Although  coffee  does  on  the  whole  far  more  good  than 
evil,  it  is  important  to  bear  in  mind  the  evils  that  it  is  able 
to  produce  under  favoring  circumstances.  In  a  general  way 
it  may  be  said  that  indoor  brain  workers  do  not  bear  coffee 
as  well  as  outdoor  muscle  workers.  Persons  of  nervous 
temperament  bear  coffee  badly. 

The  effects  of  coffee  when  pushed  to  an  excess  may  be 
to  some  extent  confused  by  the  alcohol  and  tobacco  which 
often  accompany  it,  but  they  can  be  studied  more  accurately 
in  women,  especially  in  those  who  do  not  drink  coffee,  but 
eat  it. 

As  a  rule  both  nervous  system  and  digestion  suffer  in 
these  cases.  The  appetite  fails,  there  are  attacks  of  sliarp 
epigastric  pain,  much  vertigo,  and  prolonged  headache. 
There  is  less  insomnia  than  might  be  supposed  by  those 
who  know  the  weakening  power  of  a  single  cup,  but  much 
dreaming  and  restlessness  of  a  non-aphrodisiae  type.  The 
pulse  is  weak  and  quick,   there   is  often  an  anaemic    mur- 


COFFEE   AND   TEA   INEBRIETY.  371 

mur.  The  muscles  waste  quickly.  The  coffee  inebriate 
is  always  thin.  He  may  be  a  mere  skeleton  ;  his  eyes 
are  bright  and  quick  in  movement,  their  pupils  large  ;  and 
may  be  mistaken  for  a  tea-drinker.  In  the  insomnia  wliich 
follows,  when  the  coffee  is  removed,  the  only  remedy  is  the 
old  poison. 

As  with  tea-drinking,  coffee  addiction  is  followed  by  the 
employment  of  spirits  and  other  drugs.  Many  inebriates 
and  opium-takers  have  a  history  of  excessive  use  of  coffee 
before  the  other  drugs  were  taken.  The  recognition  of 
addiction  to  coffee  is  important  in  many  cases  of  neurotics, 
especially  in  children  and  young  persons,  and  unless 
promptly  checked  will  be  followed  by  serious  results.  The 
excessive  use  of  coffee  in  all  cases  is  a  very  significant  hint 
of  nerve-exhaustion  and  disorder  of  the  motor  nerves. 

In  the  late  war  many  cases  of  delirium  from  coffee  were 
noted  where  the  food-supply  was  scant  and  coffee  was 
abundant.  Some  of  these  cases  came  under  special  treat- 
ment, and  yielded  readily  to  baths,  mineral  waters,  and 
strong  foods.  When  coffee  seems  first  to  have  been  used 
for  insomnia,  the  treatment  must  depend  on  a  careful  study 
of  tlie  etiology,  and  from  the  removal  of  the  causes  the  cure 
may  be  expected.  I  have  also  noted  a  number  of  cases  in 
young  children  of  inebriate  and  neurotic  parents  who 
developed  a  morbid  impulse  for  coffee.  Such  cases  require 
active  treatment,  and  milk,  mineral  waters,  and  baths  are 
prominent  remedies.  Neurotic  disturbances  and  diseases 
from  coffee  are  but  little  known. 

Dr.  Mendel,  of  Berlin,  has  lately  published  a  clinical 
study  of  this  neurosis,  which  is  growing  rapidly  in  this 
country.  His  observations  were  confined  to  the  women  of 
the  w(;rking  population  in  and  about  Essen.  He  found 
large  numbers  of  women  consumed  over  a  pound  a  week, 
and  some  men  drank  considerable  more,  besides  beer  and 
wine.  The  leading  symptoms  were  profound  depression  of 
spirits,  and   frequent  headaches,   with  insomnia.     A  strong 


372  DISEASES    OF   INEBRIETY. 

dose  of  coffee  would  relieve  this,  for  a  time,  then  it  would 
return.  The  muscles  would  become  weak  and  trembling, 
and  the  hands  would  tremble  when  at  rest.  An  increasing 
aversion  to  labor  and  any  steady  work  was  noticeable.  The 
heart's  action  was  rapid,  irregular,  and  palpitations  and  a 
heavy  feeling  in  the  precordical  region  were  present.  Dys- 
pepsia of  an  extreme  nervous  type  was  also  present.  Acute 
rosacea  was  common  in  these  cases.  These  symptoms  con- 
stantly grow  worse,  and  are  only  relieved  by  the  large  quan- 
tities of  coffee,  generally  of  the  infusion.  In  some  cases 
the  tincture  was  used.  The  victims  suffer  so  seriously  that 
they  dare  not  abandon  it  for  fear  of  death. 

Where  brandy  is  taken  only  temporary  relief  follows. 
The  face  becomes  sallow,  and  the  hands  and  feet  cold,  and 
an  expression  of  dread  and  agony  settles  over  the  counten- 
ance, only  relieved  by  using  strong  doses  of  coffee.  In  all 
these  cases,  acute  inflammations  are  likely  to  appear  any 
time.  An  injury  of  any  part  of  the  body  is  the  starting 
point  for  inflammations  of  an  erysipelatous  character. 
Melancholy  and  hysteria  are  present  in  all  cases.  In  this 
country  the  coffee-drinker  after  a  time  turns  to  alcohol  and 
becomes  a  constant  drinker.  In  otlier  cases  opium  is  taken 
as  a  substitute.  Coffee  inebriates  are  more  common  among 
the  neurasthenics,  and  are  more  concealed,  because  the 
effects  of  excessive  doses  of  coffee  are  obscure  and  largely 
unknown.  Man}'^  opium  and  alcoholic  cases  have  an  early 
history  of  excessive  use  of  coffee,  and  are  always  more 
degenerate  and  difficult  to  treat.  A  very  wide  field  for 
future  study  opens  up  in  this  direction. 

Dr.  Slayter  describes  a  case  of  delirium  in  a  girl  who 
chewed  large  quantities  of  tea.  It  appeared  that  masses  of 
tea  leaves  had  lodged  in  the  bowels,  and  the  delirium  was 
in  some  measure  dependent  on  the  irritation  and  reflex 
actiofi  which  followed.  Trembling  delirium,  and  delusions 
of  injury  from  others,  gave  it  a  strong  resemblance  to 
delirium   tremens.     The   amount   of  tea  chewed  daily  was 


TEA    AND    COFFEE    INEBRIETY. 


378 


over  one  pound.  The  patient  recovered  by  the  use  of  free 
cathartics  and  the  witlidrawal  of  the  tea.  In  1881  I  saw  a 
boy  wlio  had  delirium  and  trembling  that  had  existed  at 
intervals  for  two  months.  The  fact  that  his  father  had  died 
an  inebriate  seemed  to  be  a  sufficient  reason  for  his  symp- 
toms in  the  minds  of  his  friends.  It  was  ascertained  that 
he  had  for  years  drank  large  quantities  of  tea.  Having 
been  employed  in  a  tea-store,  he  had  chewed  it  freely.  He 
was  literally  a  tea  inebriate.  He  had  inherited  an  inebriate 
diathesis,  and  the  early  and  excessive  use  of  tea  was  a 
symptom  of  it.  He  had  all  the  symptoms  of  one  who  was 
using  alcohol  to  excess.  He  recovered,  and  a  year  later 
used  coffee  to  great  excess,  until  he  became  unfit  for  work  ; 
then  was  under  medical  care  for  a  time,  recovered,  and 
finally  became  an  opium-taker. 

Another  case  came  under  my  observation  in  the  person 
of  a  little  girl,  twelve  years  old,  the  daughter  of  a  patient 
under  my  care  for  inebriety.  She  had  gradually  and  stead- 
ily become  excessively  nervous.  Could  not  sleep,  had  mus- 
cular twitchings  and  delusions  of  fear  ;  would  burst  into 
tears,  and  complain  that  she  was  going  to  be  turned  out 
into  the  streets.  She  heard  voices  at  night,  and  could  not 
keep  still.  She  also  imagined  that  her  fatlier  was  being 
burned.  It  was  finally  found  that  she  was  a  tea  inebriate, 
and  botli  drank  and  chewed  it  at  all  times  and  without  any 
restraint.  A  physician  consulted  me  about  a  singular  stage 
of  trembling  and  mild  delusions  which  had  appeared  in  a 
family  of  three  old  maids  living  alone  in  the  country.  It 
was  found  to  come  from  excessive  use  of  tea,  and  to  be  tea 
inebriety.  When  this  was  stopped  they  recovered.  My 
observation  leads  me  to  think  that  these  cases  are  not  un- 
common among  the  neurotics.  They  are  of  such  a  mild 
character  at  first  as  to  escape  special  observiition,  and 
hence  are  supposed  to  be  due  to  other  causes.  Such  cases, 
after  beginning  on  tea,  take  other  drugs,  and  become  aico- 


374: 


DISEASES    OF   INEBRIETY. 


hol,  opium,  or  chloral  takers,  or  develop  some  form  of  neu- 
rosis, which  covers  the  real  and  first  causes. 

Theine  is  the  active  principle  of  the  leaves  of  Cliinese 
tea,  and  is  generally  reputed  to  be  identical  with  caffeine, 
both  in  chemical  composition  and  in  physiological  action. 
My  experiments  show  that  it  differs  very  markedly  in  physi- 
ological action  from  that  of  caffeine.  Caffeine  principally 
affects  the  motor  nerves,  while  theine  chiefly  influences  the 
sensory  nftrves,  and  clinically  proves  itself  a  most  valuable 
analgesic, surpassing  morphia  in  promptness  and  permanency 
in  relieving  pain  in  some  affections,  without  producing  any, 
or  at  least  very  little,  disturbance  of  the  general  nervous 
system.  It  paralyzes  sensation  before  motion  ;  it  impairs 
sensibility  from  the  centre  to  the  periphery  and  not,  like 
brucineand  cocaine,  from  the  periphery  to  the  centre  ;  it 
produces  convulsions  which  are  spinal  and  not  cerebral  ;  it 
has  a  more  powerful  action  on  the  sensory  nerves,  and  less 
on  the  motor  nerves  than  caffeine. 

From  the  results  of  theine  in  these  cases  it  will  be 
seen  that  it  is  a  powerful  anodyne  without  producing  any 
intoxication  of  the  higher  nerve  centres,  which  is  so  common 
with  morphia  and  all  other  agents  belonging  to  this  class. 
Its  influence  is  both  quick  and  persistent,  and  it  manifests 
an  almost  exclusive  affinity  for  the  sensory  nerves.  It 
relieves  pain  by  acting  from  the  centre  toward  the  periphery 
and  showing  its  effects  but  very  seldom  above  the  seat  of 
injection.  In  i-io,  1-5,  and  even  lA,  grain  doses  it  is  entirely 
free  from  dangerous  consequences — the  only  inconvenience 
which  it  causes  is  a  slight,  but  transient  burning  at  the 
point  of  introduction.  I  use  a  one  percent,  watery  solution 
of  Merck's  preparation — ten  minims  of  which  equal  one- 
fifth  of  a  grain  of  theine.  Larger  doses  are  required  in 
some  individuals  in  order  to  bring  out  its  characteristic 
action. 


TEA   AND   COFFEE   INEBEIETT.  375 


EFFECTS  OF  TEA  DRINKING   ON  THE   NUTRITION  OF  THE 

EYEBALLS. 

Dr.  Wolfe  has  described  the  first  effect  as  one  of  soften- 
ing of  the  vitreous  humor,  which  became  filled  with  floating 
particles  of  pigment.  It  had  come  under  his  notice  in  per- 
sons who  at  first  sight  seemed  to  have  very  little  in  common. 
He  had  found  it  among — i.  The  mining  population,  who 
pass  a  deal  of  time  underground.  2.  Washerwomen.  3, 
Middle-aged  laborers,  masons,  and  out-door  workers.  4. 
Siiop  and  factory  girls.  5.  Not  a  few  belonging  to  the 
upper  classes.  His  attention  was  specially  directed  to  the 
affection  by  its  frequent  occurrence  among  Australians  who 
came  to  consult  him.  He  could  discover  no  assignable 
cause  for  the  disease,  either  in  the  tissues  themselves  or  in 
the  history  of  the  patient  ;  and  it  was  only  on  directing  his 
inquiries  to  their  diet,  and  finding  that  ikey  all  agreed  in 
consuming  large  quantities  of  tea,  that  he  came  to  suspect 
its  agency.  A  comparison  of  the  numerous  cases  of  opacity 
of  the  vitreous  humor  occurring  among  tea-drinking  popula- 
tions, with  its  less  frequency  in  France,  Germany,  and 
America,  and  its  rarity  among  the  Turks,  tended  to  confirm 
his  suspicions.  Physiology  did  not  suggest  an  explanation, 
but  chemistry  pointed  to  theine  and  tannic  acid  as  most 
likely  to  cause  disease.  Theine  might  be  left  out  of  con- 
sideration, being  identical  with  caffeine,  which  was  innocu- 
ous ;  so  there  only  remained  tannic  acid.  This  precipitated 
albuminoids  from  their  solutions  ;  hence  it  probably  acted 
injuriously  by  precipitating  some  of  the  most  important 
constituents  of  the  food,  and  also  by  affecting  the  mucous 
membrane  of  the  stomach  and  alimentary  canal,  and  thus 
preventing  digestion  and  assimilation. 

Some  observations  had  been  made  as  to  the  effects  of 
tea-drinking  on  the  healing  of  wounds  and  ulcers,  by  a 
Glasgow  surgeon,  wlio  had  noticed  that,  in  persons  addicted 


376  DISEASES    OF   INEBRIETY. 

to  this  habit,  they  took  on  a  sort  of  scorbutic  character. 
Pliysicians  also  ascribed  numerous  cases  of  rebellious  dys- 
pepsia to  the  use  of  tea.  The  disease  of  the  vitreous  humor 
above  alluded  to,  could  hardly  be  an  isolated  pathological 
fact,  but  must  be  associated  with  deleterious  changes  in 
other  parts  of  the  economy,  and  probably  only  made  its 
appearance  in  organs  which  had  a  predisposition  to  be  so 
affected.  Without  venturing  upon  any  theory  as  to  the 
action  of  tea  on  the  vitreous  humor,  he  would  point  out 
that  the  first  expression  of  acute  irritation  of  the  fifth  nerve 
in  sympathetic  ophthalmia  was  opacity  of  the  vitreous 
humor  and  detachment  of  pigment  from  the  whole  uvular 
tract.  So  it  was  possible  that  chronic  irritation  of  the  same 
nerve  might  give  rise  to  such  changes  in  the  nutrition  of 
the  eyeball  as  to  brings  about  the  condition  under  con- 
sideration. He  commended  this  subject  to  the  notice  of 
general  practitioners,  who  had  better  opportunities  of  judg- 
ing of  it  than  he  had. 


CHAPTER  XXXVII. 

ON    PSYCHOSIS    CAUSED    BY    NICOTINE.- 

Nicotine  is  the  most  important  chemical  substance  con- 
tained in  tlie  West  Indian  plant,  nicotiana  tabaciim ;  when 
pure,  it  is  a  colorless,  easily  soluble  fluid,  of  strong  tobacco 
odor  and  very  acrid,  burning  taste,  is  easily  dissolved  in 
water,  alcohol,  and  ether,  its  reaction  being  strongly  alka- 
line, and  it  forms  simple  crystallizing  salts.  It  is  said  that 
Virginia  tobacco  contains  the  largest  quantity  of  nicotine. 
Nicotine  acts  on  the  human  organism  as  one  of  the  most 
powerful  poisons  ;  the  action  of  tobacco  differs  only  in 
degree. 

From  experiments  instituted  in  Professor  Schroff's 
laboratory  it  results  that  the  effects  of  nicotine  on  the 
healthy  organism  are  as  follows  :  Taken  in  doses  of  i  to  3 
milligrams,  the  alkaloid  produced  first  an  acrid  burning 
sensation  on  tlie  tongue  and  in  the  throat,  with  increased 
salivation,  and  a  sensation  of  heat  in  the  stomach,  in  the 
extremities,  and  in  the  whole  body.  Soon  after  this  the 
phenomena  are  headache,  vertigo,  drowsiness,  impaired 
vision  and  audition,  accelerated  and  oppressed  respira- 
tion. They  were  succeeded  within  half  or  three-quarters 
of  an  hour  after  ingestion  of  the  poison  by  an  extraordinary 
feeling  of  relaxation  and  weakness,  the  face  became  pallid 
artd  the  whole  body  as  cold  as  ice  ;  fainting  fits  and  vomit- 
ing made  their  appearance.  The  symptoms  increased  to 
tumultuous  and  chronic  spasms  of  the  respiratory  muscles. 
After  three  hours  the  symptoms  commenced  decreasing,  but 
secondary  effects  continued  for  several  days. 

377 


378  DISEASES    OP   INEBKIETY. 

Subsequent  experiments  demonstrated  tliat  tlie  first 
action  of  the  poison  is  excitation,  the  ulterior  action  is 
depression  and  paralyzation.  In  the  beginning  the  func- 
tions of  the  brain  and  of  tlie  spinal  cord  are  enhanced,  but 
this  excitation  is  followed  by  relaxation  and  debility.  The 
whole  voluntary  muscular  system  is  subjected  to  tiiis  influ- 
ence, which  gradually  extends  to  the  heart,  and  finally  to  the 
vasomotor  system.  Such  are  tlie  effects  of  this  redoubt- 
able poison  on  the  healthy  organism,  when  taken  in  small 
doses  of  I  to  3  milligrams.  Wiiat  may  be  the  effects  of  the 
1,200,000  kilograms  of  the  same  alkaloid,  constituting  the 
present  amount  produced  on  the  whole  surface  of  the  globe.? 
It  is  impossible  to  ascertain  in  an  exact  manner  the  num- 
ber of  men  using  tobacco,  but  it  is  asserted  tliat  approxi- 
mately they  number  800,000,000.  Each  of  them  consumes 
on  an  average  1%  grams  nicotine  ever}' year,  or  4  milligrams 
every  day,  some  of  them  less,  others  considerably  more. 
The  fact  that  large  doses  of  this  amount  are  supported  by 
man  proves  once  more  the  adaptability  of  the  human  nerv- 
ous system  to  injurious  habits. 

The  first  contact  with  the  tobacco  poison  is  always  felt 
by  the  cerebral  nervous  system  as  painful  and  hostile,  and 
its  repetition  requires  a  certain  violence  against  nature.  By 
not  heeding  this  warning  of  the  attacked  nervous  cell,  and 
by  repeating  the  essays  with  tlie  necessary  perseverance, 
the  repulsive  sensation  gradually  vanishes  and  the  excita- 
tion remains  as  a  stimulus,  which  soon  becomes  indispen- 
sable. At  last  the  irritation  and  debilitation  of  the  cerebral 
nervous  system  reaches  a  degree  in  which  privation  is  deemed 
a  real  suffering,  and  the  same  longing  for  renewed  enjoy- 
ment of  the  poison  manifests  itself  as  is  noted  in  alcoholists 
and  morphinists. 

The  action  of  nicotine  differs  considerably,  not  only  ac- 
cording to  the  different  classes  of  tobacco,  but  also  accord- 
ing to  its  different  applications.  Smoking  only  allows  the 
products  of  decomposition  connected  with  it  to  exercise  an 


ON   PSYCHOSIS    CA.USED   BY   NICOTINE.  379 

influence,  although  several  cases  are  known,  not  only  of  nerv- 
ous erethism,  but  even  of  perfect  psycliosis,  caused  by 
excessive  tobacco  smoking.  Kjellberg  had  several  oppor- 
tunities of  convincing  himself  that  even  a  too  abundant  use 
of  tobacco  for  snuflfing  may  originate  psychic  phenomena. 

But  the  greatest  danger  lies  in  the  use  of  tobacco  for 
chewing.  The  ordinary  sliape  for  this  application  is  to- 
bacco in  rolls.  It  is  true  that  small  doses  of  it  may  be  taken 
without  causing  psychic  injuries.  But  as  soon  as  the  daily 
use  exceeds  lo  to  12  grams  of  genuine  and  good  tobacco, 
the  field  of  pathologic  phenomena  is  approached,  and  the 
sensation  becomes  an  abnormal  one.  This  transition  is 
effected  more  rapidly  in  case  pulverized  snuff  is  used  for 
chewing.  In  the  last  decades  the  use  of  snuff  for  cliewing 
has  considerably  increased  in  various  northern  countries, 
especially  among  mariners,  manufacturing  laborers,  etc. 

From  a  number  of  cases  observed  by  him,  and  in  which 
a  continued  daily  use  of  from  20-27  grams  of  tobacco  in 
rolls,  or  in  snuff,  had  been  ascertained,  Kjellberg  has 
reached  the  conclusion  that  the  similarity  of  symptoms 
points  to  a  specific  psychosis  caused  by  the  use  of  tobacco, 
^^  nicotinosis  mentalis,"  a  real  primary  mental  disease  with  its 
own  peculiar  symptoms,  wliich  are  clinically  distinguish- 
able, and  which  give  it  a  place  among  mental  intoxications. 
"■  Nicotinosis  mentalis"  is  described  by  Kjellberg  as  follows  : 

Among  general  symptoms  a  painful  sensation  of  weak- 
ness and  impotence  is  to  be  noted,  accompanied  very  soon 
by  hallucinations,  maniacal  ideas  and  suicidal  inclination. 
Tlie  disease  has  a  prodromic  stage  and  three  distinct  stages 
differing  from  each  other. 

Prodromic  stage — The  patient  has  felt  unwell  for  some 
lime,  his  general  disposition  changes,  he  shows  an  unusual 
uneasiness  whicli  may  pass  to  a  transient  state  of  anguish. 
He  sleeps  little,  and  the  ordinary  occupations  are  repugnant 
to  him.  He  is  disposed  to  indulge  in  somber  reflections,  is 
tormented  by  palpitations  of  the  heart  and  unusual  anxiety. 


380  DISEASES   OF   INEBRIETY. 

This  condition  continues  for  one  and  one-half  and  three 
months,  when  psychosis  sets  in. 

First  stage. — The  patient's  attention  is  seized  by  lively 
hallucinations,  and  he  is  entirely  occupied  witli  these  new 
and  surprising  perceptions.  He  hears  voices,  visions 
appear  to  him,  he  lias  a  sensation  as  though  something  dif- 
ferent from  himself  was  inside  his  body,  and  strange  notions 
take  hold  of  his  conscience,  from  which  he  can't  free  him- 
self. False,  fixed  ideas  often  combine  suicidal  tendencies  ; 
his  mood  is  always  gloomy  ;  the  patient  feels  tired  and 
exhausted,  inclined  to  loneliness  and  rest  ;  at  times  he  has 
short  fits  of  fright.  Otherwise  he  is  quiet  and  obedient, 
talks  little,  and  never  without  being  previously  requested  to 
do  so,  but  then  what  he  says  is  logical  and  shows  good  per- 
ception. He  complains  of  painful  sensation  in  the  heart,  of 
wearisome  insomnia  and  of  voices  that  give  him  no  peace. 
Nutrition  is  not  impoverished,  for  the  patient  usually  eats 
plenty,  although  he  often  speaks  of  bad  appetite  and  spoiled 
food.  After  six  or  seven  months  the  disease  enters  anew 
stage. 

Second  stage. —  The  mental  disposition  improves,  and  we 
find  the  patient  talks  hilariously  of  his  perceptions.  He 
relates  the  visit  of  angels,  he  has  seen  heaven,  but  also  hell 
and  the  evil  spirits.  He  sings  and  talks  to  himself  without 
interruption  in  a  low  voice  ;  motions  become  more  vigorous, 
and  he  moves  about  with  a  certain  agitation.  The  halluci- 
nations of  brain  and  vision  are  on  the  increase,  and  the 
patient  is  constrained  to  execute  involuntary  motions.  This 
condition  is  periodic,  the  periods  usually  lasting  from  two 
to  four  weeks  with  intervals  of  indefinite  length.  In  such 
times  the  patient  lays  down  prostrated  and  lazy,  his  mood  is 
gloomy  and  discontented,  his  attention  diminished,  his  per- 
ception very  slow,  his  language  distinct  and  logical,  but 
hesitating.  This  stage  may  continue  for  a  long  time,  but 
unless  convalescence  sets  in,  it  passes  gradually  into  a  last 
stage. 


ON    PSYCHOSIS   CAUSED   BT   NICOTINE.  381 

Third  stage. — The  intervals  pass  each  other  and  periods 
of  raised  disposition  disappear  by  degrees  ;  the  mental  dis- 
position remains  quiet,  perception  is  very  limited.  Hallu- 
cinations continue,  and  the  patient  gradually  sinks  into  a 
state  of  general  psvcliic  debilit}^  while  his  physical  condi- 
tion improves,  and  lie  may  even  be  partially  serviceable 
for  ordinary  occupations. 

With  regard  to  prognosis,  it  is  not  entirely  bad  during  the 
first  and  second  stages.  But  in  the  third  stage  recovery  is  not 
to  be  expected  any  more.  Therapeutic  treatment  requires, 
first  of  all,  absolute  deprivation  of  tobacco,  with  the  under- 
standing that  it  should  be  enforced  by  degrees,  the  patient 
being  otherwise  subjected  to  very  painful  sensations  and 
much  suffering.  With  this,  substantial  diet,  motion  in  the 
open  air,  and  use  of  mineral  waters  are  to  be  recom- 
mended. 


CHAPTER   XXXViri. 

EAU  DE  COLOGNE  DRINKING  AND  ARSENIC  TAKING. 

The  use  of  cologne  as  a  substitute  for  spirits  is  very 
common  among  inebriates  ;  generally  when  no  other  form 
of  spirits  can  be  procured.  Recently  attention  has  been 
turned  to  the  rapidly  increased  consumption  of  cologne, 
both  in  large  cities  of  Europe  and  this  countr}^  and  the 
conclusion  reached  by  several  authorities  is  that  cologne  is 
becoming  a  drink  in  many  circles  in  preference  to  other 
forms  of  spirits.  To  many  persons  this  odoriferous  com- 
pound is  very  attractive,  and  especially  when  the  cologne  is 
made  with  methylated  spirits  its  spirit  strength  is  equal 
and  exceeds  many  of  the  stronger  alcoholic  drinks  in 
market. 

The  factories  for  its  manufacture  in  Cologne  use  the 
following  general  recipe  :  Twelve  drops  of  the  essential  oils 
neroli,  citron,  bergamot,  orange  and  rosemary  ;  one  drachm 
of  malabar  cardamons  to  one  gallon  of  rectified  spirits.  In 
this  country  cheap  wood  spirits  are  used,  which  gives 
greater  alcohol  strength  at  half  the  expense. 

In  England  many  women  and  men  in  the  better  walks 
of  life  begin  by  taking  a  few  drops  of  this  perfume  on  sugar 
in  the  morning  for  some  debility.  This  increases  until  they 
come  to  depend  upon  it  the  same  as  any  other  spirit  com- 
pound. It  can  always  be  purchased  with  ease  and  without 
exciting  suspicion,  and  can  be  used  with  great  secrecy. 
American  cologne  is  most  often  made  from  wood  spirits, 
and  is  a  very  fiery,  nauseous  mixture,  which  cannot  be  taken 
in  water,  but   used   on  loaf  sugar  or  lozenges  is  endurable. 

383 


384  DISRASKS    OF    INEBRIETY. 

In  one  instance  a  wine  glass  of  cologne  was  taken  tliree  or 
four  times  a  day  for  a  long  time  ;  tiie  patient  finally  died 
from  delirium  tremens.  It  appears  tiiat  the  effects  of  tiiis 
drink  vary  but  little  from  ordinary  strong  spirits,  except, 
perhaps,  tliere  maybe  more  profound  nutrient  disturbances, 
insomnia,  and  tendency  to  delirium.  If  the  cologne  is  made 
from  wood  spirits,  the  brain  and  nerve  degeneration  is  both 
intense  and  profound,  and  delirium  is  very  sure  to  follow. 

It  has  been  asserted  that  melancholia  and  insomnia  in  a 
case  suspected  of  using  spirits  in  secret  is  an  indication  of 
the  use  of  cologne.  Usually  the  cologne-drinker  will  have 
a  strong  odor  of  this  perfume  about  his  body  and  breath 
which  cannot  be  mistaken.  Such  cases  usually  use  this  per- 
fume externally  in  excess  to  divert  suspicion  from  its 
internal  use.  Undoubtedly  there  are,  in  this  country,  an 
increasing  number  of  cases  where  cologne  is  used  secretly 
and  exclusively.  These  cases,  no  doubt,  become  morphia, 
chloral,  and  cocaine  inebriates  after  a  time,  and  in  some 
instances  from  a  physician's  prescription  which  contains 
these  drugs,  that  are  often  fascinating  substitutes.  The 
alcohol  and  opium  inebriates  turn  readily  to  cologne,  and 
use  it  freely  and  with  great   satisfaction. 

The  American  inebriate,  if  a  man,  is  not  likely  to  use 
this  perfume  very  long  as  a  drink,  but  if  a  woman,  it  may 
be  taken  for  years  in  secret.  Obscure  and  complex 
nervous  disorders  in  a  woman  that  uses  cologne  externally 
should  always  suggest  the  possibility  of  its  internal  use. 
Inebriates  who  use  it  externally  and  recover  rapidly,  or 
make  sudden  changes  of  habits  and  living  may  be  sus- 
pected of  substituting  it  for  other  spirits.  Cologne,  both 
German  and  American  brands,  contains  a  large  and  vari- 
able per  cent,  of  alcohol,  and  are  always  dangerous  for  use 
among  neurotics,  even  externally.  Its  internal  use  is  very 
likely  to  follow  if  the  person  has  a  great  liking  for  this  per- 
fume. In  hospitals  for  the  treatment  of  alcohol  and  opium 
cases  cologne  is  found  to  be  as  dangerous  as  alcohol  and  is 


ARSENIC    INEBRIATES.  385 

Hot  allowed.  In  private  practice  among  neurotics  the  pos- 
sibility of  this  danger  should  always  be  considered.  It  is 
asserted  tiiat  the  sale  of  cologne  has  increased  enormously 
in  certain  sections  of  this  country.  Statistics  on  this  point 
would  be  very  interesting.  We  trust  the  coming  census 
will  throw  some  light  on  this,  and  the  extent  of  the  use  of 
bitters  in  this  country. 

ARSENIC  INEBRIATES. 

In  the  highlands  of  Styria  the  prevalence  of  inebriety  is 
limited,  if  not  directly  counteracted,  by  the  strange  habit 
of  arsenic  eating.  Beginning  with  a  minimum  quantity, 
the  devotees  of  the  baneful  drug  gradually  accustom  their 
organism  to  a  dose  that  would  prove  promptly  fatal  to  any 
non-habitue,  and  persist  in  excusing  their  practice  by  all 
sorts  of  sophisms.  Arsenic  counteracts  the  raw  air  of  the 
bleak  uplands,  it  enables  travelers  to  resist  the  fatigues  of 
mountain-climbing,  it  stimulates  digestion,  etc.,  etc. 

"  South  of  this  city  "  (Gratz),  writes  an  Austrian  physi- 
cian, "  arsenic  eaters  are  found  in  nearly  every  village; 
there  are  families  where  the  drug  is  used  by  every  male 
adult,  and  often  by  white-haired  patriarchs  of  seventy  or 
eighty  years,  for  it  must  be  conceded  that  the  habit  is  not 
incompatible  with  longevity.  As  a  rule,  I  have  been  able  to 
recognize  a  poison-eater  by  a  certain  moody  appearance, 
contrasting  strangely  with  the  jovial  disposition  of  the  high- 
landers  in  general.  A  sallow,  though  clear  and  wax-like, 
complexion,  is  another  characteristic  symptom,  and,  in  large 
doses,  the  use  of  the  drug  often  involves  serious  digestive 
dii^rders. 

"It  must  be  admitted,  however,  that  arsenic  never  pro- 
duces anytliing  like  intoxication  in  the  uglier  sense  of  the 
word.  The  poison-eat^'  directly  after  a  large  dose,  feels 
elated  ;  his  habitual  moodiness  gives  way  to  a  more 
buoyant  disposition,  but  he   does  not  become  quarrelsome 


386  DISEASES    OF   INEBRIETY. 

or  maudlin-sentimental  ;  he  can  keep  his  temper  in  a  lively 
controversy  and  the  clearness  of  his  intellect  is  not  visibly 
affected.  Nor  are  his  financial  circumstances  apt  to  be 
imperiled  by  the  habit.  At  retail  rates,  half  a  florin 
(twenty-five  cents)  worth  of  wliite  arsenic  will  keep  a  whole 
family  in  stimulants  for  a  couple  of  months.  Very  few 
inveterate  poison-eaters  can  use  up  a  florin's  worth  in  tlie 
course  of  a  year,  while  brandy  drinkers  often  waste  the 
wages  of  a  week's  hard  work  in  the  mad  revels  of  a  single 
night.  And  while  one  such  night  incapacitates  or  indis- 
poses the  toper  for  work  during  the  next  forty-eight  hours, 
an  arsenic  eater,  under  tlie  full  influence  of  his  tonic,  and 
for  hours  after,  can  follow  his  usual  occupation  as  if  noth- 
ing had  happened." 

INEBBIETY   FROM    GINGER   DRINKING. 

The  increasing  demand  for  ginger  extracts  and  drinks  is 
a  very  significant  hint  of  a  new  phase  of  the  morbid  drink 
impulses  of  the  age.  Several  large  proprietary  establish- 
ments are  devoted  exclusively  to  the  preparation  of  ginger 
extracts,  essences,  and  drinks,  which  are  extensively  adver- 
tised as  medicines  and  preventive  drinks  for  the  diseases  of 
the  different  seasons.  It  is  a  well-known  fact  that  all  these 
preparations  are  made  with  the  poorest,  cheapest  spirits, 
and  contain  from  thirty  up  to  eighty  per  cent,  of  alcohol. 
In  some  instance  wood  spirits  are  used  on  account  of  the 
clieapness,  and  the  intoxicating  qualities  of  this  mixture  are 
far  worse  than  any  alcoholic  drinks  of  commerce.  The 
demand  for  these  ginger  drinks  is  due  to  the  alcohol  they 
contain,  the  ginger  in  itself  having  but  little  influence  on 
tlie  body,  altliough  some  entliusiastic  writers  assert  that 
ginger  taken  in  large  quantities  produces  a  distinct  form  of 
inebriety,  marked  b}'  stupor  and  melancholy. 

In  two  cases  which  have  been  reported  where  extract  of 
ginger   was    taken    in   large  quantities,   profound     nutrient 


GINGER   INEBEIETT.  387 

disturbances,  and  inanition  were  present.  The  intoxication 
was  less  maniacal,  and  attended  with  profound  depression. 
This  would  undoubtedly  depend  on  the  alcohol  more  than 
the  ginger.  From  inquiries  it  appears  that  there  are  a  large 
number  of  persons  who  buy  extract  of  ginger  regularly, 
apparently  using  it  as  a  common  drink.  The  probability  is 
that  after  a  few  months  or  years  they  abandon  this  drink 
for  some  stronger  alcoholic  drinks,  or  narcotics. 

A  New  York  druggist  writes  :  "That  the  sale  of  ginger 
extracts  to  women  are  rapidly  increasing  ;  that  he  has  over 
a  dozen  regular  customers,  who  buy  from  two  quarts  to  one 
gallon  of  ginger  a  week." 

The  sale  of  ginger  in  Maine  was  so  great,  that  it  was 
declared  by  the  courts  to  be  an  intoxicant,  and  placed  among 
the  alcoholic  drinks  prohibited. 

From  a  variety  of  evidence  there  can  be  no  doubt  that 
ginger  drinking  in  this  country  has  reached  a  dangerous 
magnitude,  and  those  who  use  it  any  length  of  time  are 
almost  certain  to  become  alcoholic  or  opium  inebriates. 

The  extracts  of  ginger  on  the  market  are  without  excep- 
tion dangerous,  because  of  the  dangerous  alcohols  they  con- 
tain. Neuraesthenics  and  neurotics  should  avoid  them  as 
poison,  and  inebriates  of  every  form  will  always  find  them 
treacherous  remedies  for  every  condition.  For  all  the  vari- 
ous functional  disturbances  they  are  supposed  to  relieve, 
pure  alcohol  is  far  safer,  and  less  injurious. 

The  following  item  is  of  interest  : 

An  officer  of  a  church  accused  the  pastor  of  being  a 
ginger  inebriate.  A  trial  followed  and  Dr.  Day  was  called 
as  an  expert.  The  peculiar  conduct  of  the  clergyman,  with 
the  great  number  of  extra  ginger  bottles  found  in  his  pri- 
vate study,  with  other  evidence,  pointed  to  the  conclusion 
that  he  was  a  secret  ginger  inebriate.  Dr.  Day  said  that  for 
a  long  time  he  was  convinced  that  the  use  of  alcohol,  plain 
and  simple,  was  being  superceded  by  a  preference  for  new- 
fangled nerve  tonics  that  possessed  substantially  the  essen- 


388  DISEASES    OF   INEBRIETY. 

tial  properties  of  alcohol,  without  the  disagreeable  repu- 
tation, and  to  discover  what  peculiar  forms  this  new 
manifestation  was  taking. 

For  thirty-one  years  he  had  been  treating  nearly  one 
hundred  cases  yearly  that  displayed  all  the  symptoms  of 
alcoholic  delirium  when  the  cause  of  disease  was  not, 
strictly  speaking,  alcoholic  indulgence. 

Besides  chloral  and  cocaine  inebriates,  of  which  we 
always  have  more  or  less,  I  had  a  man  who  used  to  get 
furiously  drunk  on  quinine.  He'd  stagger  about  and  yell 
like  a  regular  whiskey  drunk,  and  he'd  go  tiirough  all  the 
successive  stages  of  a  common  intoxication.  He'd  get  jovial 
and  pleasant  first,  and  then  cross  and  savage,  and  finally 
maudlin.  He  was  a  very  interesting  case.  I  have  seen 
some  cases  suffering  from  the  effects  of  the  use  of  patent 
medicines  ;  for  instance.  Many  of  these  nerve-tonics  and 
so-called  patent  foods  are  cultivators  of  an  intemperate 
habit  that  results  in  mental  and  physical  manifestations 
very  similar  to  the  indications  of  excessive  alcoholic  indul- 
gence. A  well-known  proprietary  food  was  nothing  better 
than  an  alcoholic  stimulant. 

In  regard  to  Jamaica  ginger:  "  It  takes  tlie  strongest 
kind  of  alcoliol  to  preserve  Jamaica  ginger,  and  the  tinc- 
ture of  this  substance  is  extremely  inebriating  when  used 
even  in  small  quantities.  I  knew  a  patient  who  used  to 
get  drunk  on  a  spoonful  or  two  of  this  stuff,  and  there  isn't 
any  doubt  that  a  great  many  people  use  it  as  an  intoxicant. 
Anything  almost  acting  as  a  stimulant  to  the  nerves  may  he" 
used  as  an  intoxicating  agent.  I  knew  a  man  who  gol 
quite  drunk  on  a  strong  cigar,  and  I've  had  several  case? 
of  physical  derangement  of  pronounced  alcoholic  appear, 
ance  from  excessive  smoking.  Tobacco  and  alcohol  seem 
to  have  a  very  close  identity.  Many  a  drunkard  will  rest 
comparatively  content  when  deprived  of  his  liquor,  if  a 
good  supply  of  tobacco  is  fuinished  him,  and  many  an 
inveterate  tobacco  user  falls  into  drink  when  he  is  deprived 


GINGEK   INEBKIETY.  389 

of  the  favorite  weed.  I  knew  a  confirmed  tea-drinker  who 
was  badly  sliattered  from  tlie  excessive  indulgence  in  what 
the  poet  calls  "  the  cup  that  cheers,  but  not  inebriates,"  and 
there  are  instances  of  mild  intoxication  resulting  from  too 
much  tea-drinking. 

"  The  tendency  of  these  days  seems  to  be  toward  new 
forms  of  inebriety,  and  the  effect  of  alcoholic  indulgence 
now  is  much  more  injurious,  because  the  practice  of  adul- 
teration has  become  so  extensive.  Then  the  odium  which 
attaches  to  the  use  of  alcohol  has  led  many  people  in  high 
places  to  cultivate  a  habit  of  secret  tippling,  and  such 
people  frequently  devise  an  original  method  of  securing  the 
effect  of  inebriety  without  subjecting  themselves  to  the 
charge  of  using  alcohol.  Consequently  the  use  of  out- 
landish and  sometimes  deadly  drugs  is  clearly  on  the  in- 
crease." 


APPENDIX. 


DRUNKENNESS    AS    A    DEFENSE. 

BY    CLARK    BELL,  ESQ. 

The  law  as  now  settled  in  England  and  the  American 
States  ma}"^  be  stated  as  follows  : 

While  drunkenness  is  not  per  se  a  defense  upon  a  charge 
of  crime,  yet  mental  unsoundness,  superinduced  by  exces- 
sive intoxication  and  continuing  after  it  has  subsided,  may 
excuse  ;  or  where  the  mind  is  destroyed  by  a  long-continued 
habit  of  drunkenness  ;  or  where  the  long-continued  drunk- 
enness has  caused  an  habitual  madness,  which  existed  when 
the  offense  was  committed,  the  victim  would  not  be  respon- 
sible. For  if  the  reason  be  perverted  or  destroyed  by  a 
fixed  disease,  although  brought  on  by  his  own  vices,  the  law 
holds  him  not  accountable  :  Rex  v.  Meakin,  7  Car.  &  P., 
297  ;  Reume's  Case,  i  Lewin,  76 ;  Reniger  v.  Fogassa, 
Plow.,  I  ;  I  Russ.  on  Crimes  (9th  ed.),  12  ;  i  Bishop  Cr.  L. 
(6tii  ed.),  406  ;  i  Wharton  Cr.  L.  (8th  ed.)  sec.  48  ;  McDon- 
ald C.  L.  of  Scott.,  16  ;  I  Hale,  4  ;  Black.  Com.,  26  ;  Beasley 
V.  State,  50  Ala.,  149  ;  Peo.  v.  Odill,  i  Dak.  Ter.,  197  ;  Estes 
V.  State,  55  Ga.,  30  ;  Baily  v.  State,  26  Ind.,  422  ;  Roberts 
V.  People,  10  Mich.,  401  ;  s.  c,  19  Mete,  402  ;  State  v. 
Hundley,  46   Mo.,  414  ;  State  v.  Thompson,   12  Nev.,   140  ; 

391 


392  APPENDIX. 

Lanergan  v.  People,  50  Barb.  (N.  Y.),  266  ;  Maconnehey  7>. 
State,  5  Ohio,  77  ;  Com.  v.  Green,  Ashm.  (Pa.),  289  :  U.  S. 
V.  Forbes,  Crabbe  (D.  C),  558  ;  Stuart  v.  State,  57  Tenn., 
178  ;  Carter  v.  State,  12  Texas,  500  ;  Bell's  Med.  Jurisp.  of 
Inebriet}^  p.  10,  and  cases  there  cited). 

The  rule  of  law  is  well  settled  that  evidence  of  intoxica- 
tion is  always  admissible  to  explain  the  conduct  and  intent 
of  the  accused  in  cases  of  homicide,  although  the  rule  does 
not  apply  in  lesser  crimes,  where  tlie  intent  is  not  a  neces- 
sary element  to  constitute  a  degree  or  phase  of  the  crime. 
Bell's  Med.  Jur.  of  Inebriety,  p.  10,  and  cases  there  cited. 

In  cases  where  the  law  recognizes  different  degrees  of  a 
given  crime,  and  provides  that  willful  and  deliberate  inten- 
tion, malice,  and  premeditation  must  be  actually  proved  to 
convict  in  the  first  degree,  it  is  a  proper  subject  of  inquiry 
wiiether  the  accused  was  in  a  condition  of  mind  to  be 
capable  of  premeditation  :  Gray.  J.,  in  Hopt  v.  People,  104 
U.  S.,  631  ;  Buswell  on  Insanity,  §  450  ;  Penn  v.  McFall, 
Addison,  255  ;  Keenan  v.  Commonwealth,  44  Pa.  St.,  55  ; 
Jones  V.  Com.,  75  Pa.  St.,  403  ;  State  v.  Johnson,  40  Conn., 
136  ;  Pirttle  zk  The  State,  9  Humph.,  663  ;  Haile  v.  State,  11 
Humphrey,  154  ;  Smith  v.  Duval  (Ky.),  224  ;  Bosswell  v. 
Com.,  20  Gratt.,  860  ;  Willis  v.  Com.,  32  Gratt.,  929  ;  People 
ZK  Belencia,  21  Cal,  544;  People  v.  King,  27  Cal.,  507; 
People  V.  Lewis,  ;^6  Cal.,  531  ;  People  v.  Williams,  43  Cal., 
344  ;  Farrell  e;.  State,  43  Texas,  508  ;  Colbath  v.  State,  2 
Tex.  App.  391  ;  State  v.  White,  14  Kan.,  538  ;  Schlacken  v. 
State,  9  Neb.,  241  ;  104  U.  S. 

The  reason  of  this  rule  of  law  rests  upon  the  fact  that 
intoxication  is  a  circumstance  to  be  weighed  in  connection 
with  the  other  circumstances  surrounding  the  commission 
of  the  act  in  determining  whether  it  was  inspired  by  deliber- 
ate and  malicious  intent,  and  whether  immediately  before 
and  at  the  time  of  his  act  the  intoxication  of  the  accused 
was  so  great  as  to  render  him  incapable  of  forming  a  design 
or  intent,  which   the  jury  must  find  from  the  facts  in  the 


APPENDIX.  393 

case,  without  regard  to  the  opinions  of  others:  Buswell  on 
Insanity,  §  452  ;  Marshall's  Case,  i  Lew.  Cr.  Cas.,  76  • 
Thacher,  J.,  in  Kelly  v.  State,  3  S.  &  M.,  518  ;  Armor  v. 
State,  63  Ala.,  173  ;  People  v.  Belencia,  21   Cal.,  54. 

And  because,  since  he  who  voluntarily  becomes  intoxi- 
cated is  subject  to  the  same  rules  of  law  as  the  sober  man, 
it  follows  :  that  where  a  provocation  has  been  received 
whicii,  if  acted  upon  instantly,  would  mitigate  the  offense  if 
committed  by  a  sober  man,  the  question  in  the  case  of  a 
drunken  man  sometime  is,  whether  such  provocation  was  in 
fact  acted  upon,  and  evidence  of  intoxication  may  be  con- 
sidered in  deciding  that  question  :  Buswell  on  Insanity,  § 
423  ;  State  v.  McCants,  i   Speer,  384. 

The  New  York  Penal  Code  defines  precisely  this  ques- 
tion of  responsibility  in  that  State  in  such  cases  as  follows  : 
"§  22.  Intoxicated  persons. — No  act  committed  by  a  per- 
son while  in  a  state  of  intoxication  shall  be  deemed  less 
criminal  by  reason  of  his  having  been  in  such  condition. 
But  whenever  the  actual  existence  of  any  particular  pur- 
pose, motive,  or  intent,  is  a  necessary  element  to  constitute 
a  particular  species  or  degree  of  crime,  the  jury  may  take 
into  consideration  the  fact  that  tiie  accused  was  intoxicated 
at  the  time,  in  determining  the  purpose,  motive,  or  intent, 
with  which  he  committed  the  act." 


DELIRIUM  TREMENS  AND  THE  LAW. 

The  rule  of  law  is  well  established  both  in  Engand  and 
the  United  States,  that  insanity  produced  by  delirium  tre- 
mens is  a  good  defense  to  a  ci'iminal  charge.  Even  if 
induced  by  intoxication,  the  victim  is  no  more  punishable 
for  ills  acts  than  if  the  delirium  had  resulted  from  causes 
not  under  his  control  :  Regina  v.  Davis,  14  Cox  C.  C,  563  ; 
Bell  on  Med.  Juris,  of  Inebriety,  9,  and  cases  there  cited  ; 
J.  Crisp    Poole,  Med.    Leg.  Jour.,    vol.    8,  p.  44  ;    U.    S.  V. 


394:  APPENDIX. 

McGIue,  I  Curt.,  i  ;  Wharton's  Crim.  Law  (8th  ed.),  sec.  48  ^ 
People  V.  Williams,  43  Cal.,  344  ;  U.  S.  v.  Clarke,  2  Cr.  C.  C, 
758  ;  Lanergan  v.  People,  50  Barb.  (N.  Y.),  266  ;  s.  c,  6 
Parker,  Cr.  R.  (N.Y.),  209  ;  O'Biien  v.  People,  48  Barb.,  274  ; 
State  V.  Dillahunt,  3  Harr.  (Del  ),  551  ;  State  v.  McGonigal, 
5  Harr.  (Del.),  510  ;  Cluck  v.  State,  40  Ind.,  563  ;  Bradley 
V.  State,  26  Ind.,  423  ;  O'Herrin  v.  State,  14  Ind.,  420  ; 
Dawson  v.  State,  16  Ind.,  428  ;  Fisher  v.  State,  64  Ind.,  435  ; 
Smith  V.  Com.,  i  Day  (Ky.),  224  ;  Roberts  v.  People,  10 
Mich.,  401  ;  State  v.  Hundley,  46  Mo.,  414  ;  State  v.  Sewell, 
3  Jones  (N.  C),  L.,  245  ;  Corn  well  v.  State,  Mart  &  Y. 
(Tenn.),  147  ;  Carter  v.  State,  12  Tex.,  500  ;  Boswell  v. 
Com.,  30  Gratt.  (Va.),  860  ;  U.  S=  v.  Drew,  5  Mason  C.  C.» 
283. 


INDEX. 


Page 

Accidental  Inebriates 27 

Adversity  in  Inebriety 80 

Alcoholic  Delirium  and  its 
associated  conditions. .. .   131 

Alcoholic  Heredity 145 

Alcohol  as  a  Paralizant. . .   181 
American    Association    for 
the  Study  and  Cure   of 

Inebriety 5,  25 

Anstie,  Dr 167 

Arsenic  Inebriety 383 

Asylums,  History  of 22,  215 

Asylums  in  America 24 

Alchol  and  Beer  on  the  brain  113 

Beard,  Dr.  G.  M 73-93 

Beer     Drinking      in     this 

Country 116 

Bellows,  Dr 202 

Bell,  Clark 277,285 

Blandford,  Dr 164 

Binghampton  Asylum, 

24,  76,  216 

Carpenture,  Dr 247 

Cholera  in  Inebriety 102 


Page 

Chronic  Dipsomania,    35 

Chloroform  Inebriety 363 

Clouston,  Dr 113 

Climatic      period     in     Ine- 
briety     119 

Classification  of  Inebriety. .     27 
Climate  in  Inebriety.  .65,  93,  124 

Coma  in  Inebriety 306 

Cocaine  Inebriety 357 

Consumption  in  Inebriety. .   103 
Conditions     favoring    Ine- 
briety       39 

Connor,  Dr 363 

Cofifee  Inebriety 369 

Cologne  Inebriety 383 

Connecticut   State  Medical 

Society 21 

Crothers,  T.  D., 

17,  55,  66,  116,  145,  316,  297 

Criminal  Inebriates 289 

Cure   of  Inebriety 198 

Day,    Dr.  Albert, 

213,223,  374,  387 
Dacaiene,  Dr 170 


398 


INDEX. 


Page 
Delirium  Tremens,  Febrile.    137 
Delirium  Tremens  Trauma- 
tics 142 

Details  of  Treatment 203 

DeZouche,  Dr.   239 

Disease  theory,  History  of  17 
Disease  theory    in  Modern 

Times 22 

Dipsomania,  its  History  and 

Relation 29 

Disability    of     Alcoholized 

Cases "]"] 

Diathesis  Inebriate 52 

Dietetic    diseases    in   Ine- 
briety      57 

Diagnosis  of  Inebriety 118 

Differentiation  of  Inebriety.  309 
Drinking  from  Association  175 
Duty  of  State  in  Treatment 

of  Inebriates 239 

Dyspepsia  57 

Early  history  of  Dipsomania     3 1 

Education  in  Inebriety 59 

Emotional  Inebriates 28 

Elliott,  Dr 209 

Epilepsy,    its     relation     to 

Inebriety 48 

Ether  Inebriety 347 

Exhaustion  in  Inebriety... 70,  80 

Fort      Hamilton      Inebriate 
Home 123,  256 

Head  Injuries  in  Inebriety. .  31 

Heredity,  Opium 319 

Heredity,  Alcoholic 145 

Heredity,  Psychical 147 


Page 

Heredity,  History  of 155 

Heredity,  its  Extent  and.. 

Statistics 156 

Hughes,  Dr.  C.  H 317 

Hospitals  in  Europe 25 

Inebriety  and  Coma 309 

Inebriety  from  Opium 317 

Inebriety  from  Ether 347 

Inebriety  from  Cocaine....  357 
Inebriety  from  Chloroform  363 
Inebriety  from    Coffee   and 

Tea 369 

Inebriety  from  Tobacco. . . .  377 
Inebriety  from  Cologne. .. .    383 

Inebriety  from   Arsenic 385 

Inebriety  from  Ginger 386 

Inebriate  Asylums.  .24,  203,  217 
International    Congress   for 
the  Study  of  Inebriety.  26,  92 

Insanity  of  Inebriates 242 

Inebriety,      Predisposing 

Causes 55 

Inebriety  among  Women..     61 

I  nebriety  from  Heat 63 

Inebriety  and  Sun-stroke.  .86,  87 
Inebriety       among       many 

American  Women 92 

Inebriety  in  Epidemics....    102 
Inebriety      and     Consump- 
tion      103 

Insanity  and  Inebriety.  .242,  271 
Inebriate  Asylums,  History 

of 22,  217 

Inebriates  in  Asylums 246 

Inebriate,  Legal  Control  of, 

221,  253 

Inebriates,  Criminal 302 

Inebriate's  Responsibility..   283 


IHDEX. 


899 


Page 
Inebriety,  Law  and  Rulings 

of 276 

Irresponsibility  of  Inebriates  297 

Jackson,  Dr..... 83,227 

Jewell,  Dr.  J.  G 182 

Journal  of  Inebriety. ....  .vi.,  25 

Kemp,  Dr.  E.J 187 

Kerr,  Dr.  Norman, 

168,  174,  243,271,  277,  347 

Law  and  rulings  of  Judges 

in  Inebriety 277 

Lett,  Dr.  Stephen 222 

Lentz,  Dr.  F 260 

Legal  care  of  Inebriates. 221,  253 
Lykke,  Dr 29,  171 

Maudsley  Dr 59 

Mays,  Dr.  Thos.  J 103 

Mason,  Dr.  L.  D., 

118,  123,  220,  251 

Mann,  Dr.  E.  C 206 

Mattison,  Dr.  J.  B. .232,  329,  340 

Marriage  and  Heredity 152 

Matthews,  Dr 161 

Mendel,  Dr 360 

Mental  Heredities I47 

Military  Hospitals 200 

Morris,  Dr.  John 309 

Morel,  Dr 163 

Mortality  of  Inebriety 100 

New  York  State   Inebriate 

Asylum 23 

Neursesthenia  in  Inebriety, 

81,  1S2 
Nicotine 377 


Page 
Occupation  of  Inebriates. . .    123 

Opium  Inebriety 317 

Opium  Neuroses 313 

Opium  Diathesis 321 

Opium  Classes 319 

Opium  allied  diseases 317 

Opium  Special  Treatment. .   329 

Opium  Heredity 331 

Opium  Medical  Treatment.    329 

Parrish,  Dr.  J 119,  244 

Pathology  of  Brain  Feeble- 
ness       39 

Pauper  Inebriates 28,  251 

Pathology  of  Inebriety.  173,  185 

Periodic  Dypsomania 29 

Politics  in  Inebriety 76,  98 

Philosophy  of  Inebriety 41 

Predisposing  Causes  of  Ine- 
briety      55 

Premeditation  in  Inebriety, 

TJ,  122,  146 
Prognosis  of  Inebriety. .  197,  209 
Psychical     Traumatism    in 

Inebriety 73 

Psychological  Forces  in  Ine- 
briety       90 

Punishment  does  not  deter 
Inebriates 198 

Quimby,  Dr.  I.  N 241 

Rest  in  Inebriety 182 

Results  of  Treatment..  .128,  183 
Responsibility  of  Inebriates.  2S3 

Richardson.  Dr.  B.  W 258 

Roberts,  Dr.  John  B 139 

Rush,  Dr 19 


400 


INDEX. 


Page 

Searcey,  Dr.  J.  T 39 

Shepard,  Dr.  C.  H 234 

Slayter,  Dr 372 

Solitary  Inebriates   28 

Special  Hospitals  for  Inebri- 
ates      220 

Statistics  of  Heredity.  ..156,  161 
State  Hospitals  for  Inebri- 
ates   248,  260 

Syphilitic  Diathesis 54,  377 

Temperature  in  Inebriety. .     84 
Tea  Drinking  on  the  eyes. .   375 

Tea  Inebriety 376 

Thwing,  Dr.  E.  P 90 

Theane  Inebriety 372 

Tobacco  Inebriety 377 

Treatment,  General  Princi- 
ples     197 

Transmissibility  of  Inebriety  168 

Tuke,  Dr 165 

Treatment  by  Hot-air 234 

Treatment  by  the  State 239 

Trance  in  Inebriety 297 

Treatment,  Failure  of, 

85,  150,  240 


Page 
Treatment,  Duration  of, 

306,  248,  256 

Treatment,  Form  of 215 

Treatment  by  Restraint 255 

Treatment  by  Medicines. 206,  21 1 
Treatment,  Results  of. .  128,  197 

Treatment,  Hygienic 227 

Traumatic     Delirium    Tre- 
mens   142 

Treatment  of  Delirium  Tre- 
mens     143 

Treatment     of      cases      of 

Heredity 150 

Traumatism  in   Inebriety..     66 

Turner,  Dr.  J.  Edw 22.  216 

Types  of  Inebriates 29 

Washingtonian  Movement.     22 

Washingtonian  Home 22 

Women    Inebriates 61 

Wolf,   Dr 375 

Winslow,  Dr.  Forbes 166 

Woodard,  Dr 21,215 

Wright,  Dr.  T.  L., 

47,  162,  173,  179.  270 
Wynter,  Dr i66 


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